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国际外科学杂志
国际外科杂志编辑部
国际外科学杂志

国际外科杂志编辑部

刘建

月刊

1673-4203

gjwkx@263.net

010-63138570

100050

北京市首都医科大学附属北京友谊医院

国际外科学杂志/Journal International Journal of Surgery北大核心CSTPCD
查看更多>>1974年创刊，中华人民共和国卫生部主管，中华医学会、首都医科大学附属北京友谊医院主办。本刊原《国外医学?外科学分册》，自2007年起变更为月刊，2008年入选中国科技论文统计源期刊。本刊栏目丰富，题材新颖，信息量大、时效性强、几乎涵盖外科领域的各个专题。主要栏目有专家论坛、专题笔谈、论著、综述、国际医学动态、临床病例解析、手术技巧集萃、手术并发症等，为读者及时提供前沿信息
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    机器人手术系统在甲状腺外科应用中的失误与对策

    贺青卿王猛
    1-7页
    查看更多>>摘要：甲状腺微创手术的目的是通过智能的操作系统进行精细化手术，实现患者的身体和心理微创，从而提高生活质量。目前，常用微创手术方式包括腔镜手术和机器人手术，均是通过远距离创建隧道至甲状腺进行操作，对手术器械和机器人外科医师的技术要求很高。无论哪种微创手术方式，在开展初期，医师对系统、器械、操作方法及手术思维都有一个接触、了解、熟练掌握和拓展创新的过程，在这个过程中难免会遇到一些失误操作，这些失误操作又是导致包括并发症在内医疗安全不良事件的主要原因，给患者带来失败的就医体验。同时，失误也会给机器人外科医师造成心理负担，给新技术的开展造成影响。失误的发生还取决于机器人外科医师的开放手术经验及临床应变能力，经验丰富的机器人外科医师可明显降低失误。随着医疗技术的革新和患者对疗效及美容的迫切需求，失误不应是阻挡甲状腺微创手术发展的因素。本文通过分析机器人外科医师的失误操作，制定对策，为机器人手术的安全开展提供借鉴，从而促进智能、精准、微创外科的发展，进一步造福有微创需求的患者。 The purpose of minimally invasive thyroid surgery is to perform refined surgery through an intelligent operating system, achieving minimal physical and psychological trauma for patients, thereby improving their quality of life. At present, the commonly used minimally invasive surgical methods are laparoscopic surgery and robotic surgery, both by creating tunnels from a distance to the thyroid gland, requiring high technical requirements for surgical instruments and robotic surgeons. Regardless of the type of minimally invasive surgery, in the early stages of implementation, doctors have a process of exposure, understanding, proficient mastery, and innovative expansion of the system, instruments, operating methods, and surgical thinking. In this process, it is inevitable to encounter some erroneous operations, which are the main causes of medical safety adverse events, including complications, and bring a failed medical experience to patients. At the same time, mistakes can also cause psychological burden for robotic surgeons and have an impact on the development of new technologies. The occurrence of errors also depends on the open surgical experience and clinical adaptability of robotic surgeons, and experienced robotic surgeons can significantly reduce errors. With the innovation of medical technology and the urgent demand of patients for efficacy and beauty, errors should not be a factor hindering the development of minimally invasive thyroid surgery. This article will analyze the erroneous operations of robot surgeons, formulates countermeasures, and provides reference for the safe implementation of robot surgery, thereby promoting the development of intelligent precision minimally invasive surgery, and further benefiting patients with minimally invasive needs.

    甲状腺肿瘤机器人外科手术,微创性失误对策智能精准微创外科机器人外科医师

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    甲状腺腔镜手术中甲状旁腺保护技术

    殷德涛冯贵铖
    7-11页
    查看更多>>摘要：外科手术是目前临床治疗甲状腺疾病的重要手段，尤其是在保守治疗无法有效改善的情况下，更应该采用外科手术来进行治疗。随着甲状腺腔镜技术的不断成熟及人们对手术美容的需求增加，甲状腺腔镜手术进行得越来越多。甲状腺腔镜手术具有切口小、出血少、术后并发症少、瘢痕组织少等优点，现已得到临床认可。虽然腔镜手术在甲状腺疾病治疗中取得了显著效果，但术中如何有效地保护甲状旁腺，避免发生甲状腺功能减退是目前外科医师关注的难点之一。本文对甲状腺腔镜手术中甲状旁腺的识别及保护技术进行分析与总结，以期为临床提高对腔镜手术中甲状旁腺的保护技术提供参考依据。 Surgery is an important means of clinical treatment of thyroid diseases. For thyroid diseases that have failed conservative treatment, surgical treatment is recommended. With the maturation of thyroid endoscopy technology and the increasing demand for cosmetic surgery, more and more thyroid endoscopic surgeries are being performed. Endoscopic thyroid surgery has the advantages of small incision, less bleeding, less postoperative complications, less scar tissue, and so on, which has been clinically recognized and approved. Although endoscopic surgery has achieved remarkable results in the treatment of thyroid diseases, how to effectively protect the parathyroid gland during surgery and avoid hypothyroidism is one of the difficulties that surgeons pay attention to. In this paper, the identification and protection techniques of the parathyroid gland during endoscopic thyroid surgery were analyzed, and summarized, in order to provide a reference for improving the protection techniques of the parathyroid gland during endoscopic thyroid surgery.

    甲状腺肿瘤甲状旁腺外科手术腔镜手术功能保护

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    盆底重建在直肠癌腹腔镜低位直肠前切除术中的意义和方法

    张小桥
    12-16页
    查看更多>>摘要：腹腔镜低位直肠癌前切除术形成的盆底残腔容易导致盆腔感染扩散、粘连性肠梗阻，并可能增加放疗患者放射性肠损伤发生概率。手术中重建盆底能够避免小肠坠入骶前残腔，减少肠梗阻和放射性肠损伤的风险，预防或减轻吻合口漏等并发症的发生及其严重程度，还能够在一定程度上改善低位前切除术后肛门功能，提高患者生命质量。直接缝合盆底腹膜和带蒂大网膜填充是目前常用的2种盆底重建方式，操作较为简单，容易推广，值得常规应用。 The residual pelvic floor cavity formed by laparoscopic low anterior resection for rectal cancer can result in some complications, such as spread of pelvic infection following anastomotic leakage, adhesive intestinal obstruction, and may increase the probability of radiation intestinal injury in case of postoperative radiotherapy. Reconstructing the pelvic floor can prevent the small intestine from entering the residual cavity, reduce the risk of intestinal obstruction and radiation induced intestinal injury prevent or reduce the occurrence and severity of anastomotic leakage. Reconstructing the pelvic floor can also improve the anal function after low anterior resection to a certain extent and enhance the quality of life of patients. Direct suturing of the pelvic floor peritoneum and pedicled greater omentum flap graft transplantation are currently two commonly used pelvic floor reconstruction methods, which are relatively simple to operate, easy to promote, and worthy of routine application.

    直肠肿瘤腹腔镜骨盆底低位前切除术大网膜

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    系统免疫炎症指数联合中性粒细胞淋巴细胞比值检测在晚期胃癌免疫治疗中的意义

    王振峰常俊朋隋德岭刘广勇...
    16-21页
    查看更多>>摘要：目的 分析系统免疫炎症指数(SII)联合中性粒细胞淋巴细胞比值(NLR)在晚期胃癌PD-1/PD-L1抑制剂治疗中的意义。 方法 回顾性分析2020年1月—2023年1月接受免疫治疗的90例Ⅳ期胃腺癌患者的病例资料，其中男性70例，女性20例，年龄36～80岁，平均年龄(53.76±15.58)岁。收集患者的临床病理特征及随访资料。采用SPSS 26.0软件进行统计学分析。计算NLR、SII、PLR和MLR的临界值，分析不同标志物水平患者的总生存期和无进展生存期(PFS)，确定PFS和总生存期的独立预测因素，评估危险因素对胃癌患者PFS和总生存期的预测价值。 结果 所有患者中位随访时间为27.3个月，中位PFS和总生存期分别为10.0个月和17.7个月。NLR和SII预测PFS和总生存期的曲线下面积(AUC)均>0.7，临界值NLR分别为4.75和3.85，SII分别为1154.67和887.90。高NLR、高MLR、高PLR和高SII患者的PFS和总生存期均低于低水平患者。ECOG PS≥1、高NLR和高SII是疾病进展或死亡的独立影响因素。NLR、ECOG PS和SII组合的AUC为0.761，预测效能高于任何单因素，危险因素数量越少的患者PFS和总生存期越长。 结论 在接受免疫治疗的晚期胃癌患者中，NLR和SII是PFS和总生存期的有效预测因素，治疗前检测NLR和SII能够为晚期胃癌免疫治疗提供可靠指导。 Objective To analyze the significance of systemic immune inflammatory index (SII) combined with neutrophil lymphocyte ratio (NLR) in the treatment of advanced gastric cancer with PD-1/PD-L1 inhibitors. Methods The clinical data of 90 patients with stage Ⅳ gastric adenocarcinoma who received immunotherapy from January 2020 to January 2023 were retrospectively analyzed, including 70 males and 20 females, aged from 36 to 80 years, with an average age of (53.76±15.58) years. The clinicopathological features and follow-up data were collected. SPSS 26.0 software was used to conduct statistical analysis. The critical values of NLR, SII, PLR and MLR were calculated, and the overall survival (OS) and progression free survival (PFS) of patients with different levels of markers were analyzed. The independent predictive factors of PFS and OS were determined, and the predictive value of risk factors for PFS and OS in patients with gastric cancer was evaluated. Results The median follow-up time of all patients was 27.3 months, and the median PFS and OS were 10.0 months and 17.7 months, respectively. The area under the curve (AUC) of NLR and SII for predicting PFS and OS were>0.7, the critical values NLR were 4.75 and 3.85, and SII were 1154.67 and 887.90, respectively. PFS and OS in patients with high NLR, high MLR, high PLR and high SII were lower than those in patients with low levels. ECoG PS≥ 1, high NLR and high SII were independent influencing factors of disease progression or death. The AUC of the combination of NLR, ECoG PS and SII was 0.761, which was higher than that of any single factor. The fewer the number of risk factors, the longer the PFS and OS. Conclusions NLR and SII are effective predictors of PFS and OS in patients with advanced gastric cancer receiving immunotherapy. Pre treatment detection of NLR and SII can provide reliable guidance for immunotherapy of advanced gastric cancer.

    血清反应因子预后胃肿瘤

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    更正声明

    21页
    查看更多>>摘要：发表于我刊2023年第5期，第一作者为孙萌的文章，原目录中论文题目更正为《青少年减重与代谢手术患者临床特点分析》；作者贡献声明中，更正为"刘洋、刘佳：对文章的知识性内容作批评性审阅"。特此更正。
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    远端胃大部切除术后短期并发症的Clavien-Dindo分级及危险因素分析

    孙伟张忠涛
    22-27页
    查看更多>>摘要：目的 探讨远端胃大部切除(DG)短期(术后30 d内)并发症的Clavien-Dindo(CD)分级情况及影响该分级的相关危险因素。 方法 回顾性分析2016年1月—2021年12月首都医科大学附属北京友谊医院经同一术者完成的230例行DG的胃癌患者的临床资料，其中男性159例(69.1%)，女性71例(30.9%)，年龄31～80岁，平均年龄(61.69±10.91)岁；平均体重指数(23.59±3.46) kg/m2；计数资料组间比较采用χ2检验或Fisher确切概率法，等级资料进行组间比较采用秩和检验。多因素分析采用逐步法Logistic回归。 结果 本研究中，共有30例(13.0%)患者出现CD-Ⅱ级及以上术后并发症，其中Ⅱ级20例(66.7%)，Ⅲ级8例(26.7%)，Ⅳ级2例(6.6%)，在30例并发症的患者中，单纯吻合口瘘2例，吻合口出血2例，十二指肠残端漏3例，腹腔感染2例，肠梗阻6例，肺部感染5例，切口感染2例，胃排空延迟2例；肺部感染合并肺不张3例，吻合口瘘合并腹腔感染2例，肺部感染、腹腔感染合并肠梗阻1例。手术途径是DG术后并发症的独立危险因素(P<0.05)，不同手术途径患者的术后并发症CD分级差异无统计学意义(P>0.05)。 结论 肺部感染、肠梗阻、腹腔感染和吻合口瘘是DG术后的主要并发症，导致并发症的独立危险因素为手术途径，但手术途径不影响并发症CD分级。 Objectives To explore the Clavien-Dindo (CD) classfication of short-term (within 30 days postoperative) complications of distal major gastrectomy (DG) and the associated risk factors affecting this classification. Methods A retrospective analysis was conducted on the clinical data of 230 patients with gastric cancer who underwent DG completed by the same operator at Beijing Friendship Hospital, Capital Medical University from January 2016 to December 2021. There were 159 males (69.1%) and 71 females (30.9%), aged from 31 to 80 years, with an average age of (61.69±10.91) years, all patients average body mass index was (23.59±3.46) kg/m2. Chi-square test or Fisher exact probability method was used to compare the count data between groups, and rank sum test was used to compare the rank data between groups. Multiple factors were analyzed by stepwise Logistic regression. Results In this study, a total of 30 cases (13.0%) experienced CD grade Ⅱ or higher postoperative complications. Among them, 20 cases (66.7%) were grade Ⅱ, 8 cases (26.7%) were grade Ⅲ, and 2 cases (6.6%) were grade Ⅳ, Among the 30 patients with complications, there were 2 cases of simple anastomotic leakage, 2 cases of anastomotic bleeding, 3 cases of duodenal stump leakage, 2 cases of intra-abdominal infection, 6 cases of intestinal obstruction, 5 cases of pulmonary infection, 2 cases of incision infection, 2 cases of delayed gastric emptying, 3 cases of pulmonary infection combined with atelectasis, 2 cases of anastomotic leakage combined with intra-abdominal infection, and 1 case of pulmonary infection and intra-abdominal infection combined with intestinal obstruction. Pulmonary infection, intestinal obstruction, and anastomotic leakage were the main postoperative complications of DG. The surgical approach was an independent risk factor for postoperative complications (P<0.05), and there was no statistically significant difference in the grade of postoperative complications of patients with different surgical methods(P>0.05). Conclusions Pulmonary infection, intestinal obstruction, abdominal infection, and anastomotic leakage are the main postoperative complications of DG. The independent risk factor for complications is the surgical approach, but the surgical approach does not affect the CD grading of complications.

    胃肿瘤手术后并发症危险因素远端胃大部切除术Clavien-Dindo

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    广泛粘连性小肠梗阻术中经鼻置入肠梗阻导管的临床疗效评价

    高峰杜彦斌寇天阔邵建平...
    27-31页
    查看更多>>摘要：目的 分析在广泛粘连性肠梗阻(ABO)术中置入经鼻肠梗阻导管(NIT)的可行性和临床有效性。 方法 回顾性分析首都医科大学大兴医院普外科于2019年4月—2021年4月之间收治的60例广泛ABO患者的临床及随访资料，其中30例术中行NIT小肠内排列术(观察组)，30例同期未行NIT小肠内排列术(对照组)。观察组中男性12例，女性18例；对照组中男性16例，女性14例。比较两组患者手术时间、胃肠功能恢复时间、出院时间、总有效率以及术后并发症发生率，术后24个月肠梗阻复发率计量资料以均数±标准差(±s)表示，组间比较采用t检验；计数资料以例(百分比)[n(%)]表示，组间比较采用χ2检验。 结果 所有患者均顺利完成手术并顺利出院。对照组和观察组总有效率比较差异无统计学意义(χ2＝3.16，P＝0.237)。观察组手术时间略长于对照组[(110.6±4.6) min比(94.3±2.5) min，t＝17.27，P＝0.001]；观察组胃肠功能恢复时间与住院时间均短于对照组[(8.13±1.00) d比(8.70±0.70) d，t＝2.53，P＝0.014；(12.83±1.57) d比(13.67±1.03)d，t＝0.03，P＝0.018]，术后并发症发生率低于对照组(10%比30%，P＝0.028)，差异有统计学意义。 结论 术中应用NIT是安全有效的，可明显降低术后肠梗阻的复发率。 Objective To evaluate the feasibility and clinical effectiveness of placing a nasointestinal ileus tube (NTI) during extensive adhesive bowel obstruction (ABO) surgery. Methods A retrospective analysis was performed for the clinical and follow-up data of 60 patients with extensive ABO admitted to the Department of General Surgery of Daxing District Hospital of Capital Medical University from April 2019 to April 2021, of which 30 patients underwent intraoperative NIT intraintestinal alignment (observation group) and 30 patients who did not undergo NIT intraintestinal alignment (control group) during the same period. There were 12 males and 18 females in the observation group. There were 16 males and 14 females in the control group. The operation time, gastrointestinal function recovery time, discharge time, total effective rate and postoperative complication rate were compared between the two groups, and the quantitative data of the recurrence rate of intestinal obstruction at 24 months after surgery were expressed as mean ± standard deviation (±s), and the t-test was used for comparison between groups. Numerological data were presented as cases (percentage) [n (%)], and chi-square tests were used for comparison between groups. Results All patients were successfully completed the surgery and discharged from the hospital. There was no statistically significant difference in total effective rate between the control group and the observation group(χ2=3.16, P=0.237). The surgical time in the observation group was slightly longer than that in the control group [(110.6±4.6) min vs (94.3±2.5) min, t=17.27, P=0.001]. The recovery time of gastrointestinal function and hospitalization time in the observation group were shorter than those in the control group[(8.13±1.00) d vs (8.70±0.70) d, t=2.53, P=0.014 (12.83±1.57) d vs (13.67±1.03) d, t=0.03, P=0.018]. The incidence of postoperative complications was lower than that in the control group (10% vs 30%, P=0.028), and the difference was statistically significant. Conclusion Intraoperative application of NIT is safe and effective, and can significantly reduce the recurrence rate of postoperative intestinal obstruction.

    肠梗阻消化系统外科手术导管插入术

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    CpG岛甲基化结肠癌临床特点及其在dMMR结肠癌中的预后意义

    刘媛王瑞丽王丹玲宋建宁...
    32-37页
    查看更多>>摘要：目的 探讨CpG岛甲基化(CIMP＋)结肠癌的临床特点和预后，以及CIMP状态在错配修复缺陷(dMMR)结肠癌的诊断和预后预测中的指导意义。 方法 以关键词"colorectal cancer""patient"和"CpG Island Methylator Phenotype"检索基因表达数据库(GEO)，得到序列号为GSE39582的数据，共纳入585例结肠癌患者临床资料和肿瘤组织的全转录组测序数据。排除CIMP为缺失值的72例后纳入513例进一步分析，其中男性278例，女性235例，平均年龄(67±13)岁。根据CIMP状态分为CIMP＋组(n＝93)和CIMP-组(n＝420)，比较两组临床特点差异，绘制Kaplan-Meier生存曲线比较总生存期和无病生存期差异；提取dMMR亚组71例，分为CIMP＋组(n＝43)和CIMP-组(n＝28)，K-M曲线分析两组总生存期和无病生存期差异。组间比较采用t检验、χ2检验或者Mann-Whitney U非参数检验，生存曲线组间差异性检验采用Long-rank检验。 结果 CIMP＋组患者年龄大于CIMP-组[(70.84±12.60)岁比(66.21±13.08)岁，t＝3.18，P＝0.002]；右半结肠肿瘤起源于CIMP＋分子通路途径是左半结肠癌起源于CIMP＋的9.3倍(OR＝9.3，95%CI：5.2～17.9)；BRAF突变型结肠癌起源于CIMP＋是BRAF野生型结肠癌起源与CIMP＋的215.2倍(OR＝215.2，95%CI：53.2～1906.7)；dMMR结肠癌患者起源于CIMP＋是pMMR患者的12.8倍(OR＝12.8，95%CI：7.0～23.9)。CIMP＋和CIMP-两组在总生存期和无病生存期方面差异无统计学意义(P＝0.590、0.220)。在dMMR结肠癌亚组中，CIMP状态与患者总生存期和无病生存期无相关性(P>0.05)。 结论 CIMP＋结肠癌患病人群多为高龄，肿瘤起源有右半结肠，多合并BRAF基因突变，表现为错配修复缺陷dMMR结肠癌。CIMP状态与结肠癌TNM分期及生存预后无相关性。CIMP＋所致dMMR结肠癌与MMR基因突变所致dMMR结肠癌，生存预后无显著差异。 Objective To investigate the clinical characteristics and prognosis of CpG island methylator phenotype (CIMP+ ) colon cancer, and the significance of CIMP status in the diagnosis and prognosis prediction in defective mismatch repair (dMMR) colon cancer. Methods The keywords "colorectal cancer" "patient" and "CpG Island Methylator Phenotype" were used to search the Gene Expression Omnibus (GEO) database, and the GSE39582 was obtained, which included the clinical data of 585 patients with colorectal cancer and the sequencing data of the whole transcriptome of the tumor tissues. After excluding 72 cases with missing CIMP values, 513 cases were included for further analysis, including 278 males and 235 females, with a mean age of (67±13) years. According to the CIMP status, they were divided into CIMP+ group ( n=93) and CIMP-group (n=420), then compare the differences in clinical characteristics, the Kaplan-Meier survival curves were plotted to compare the overall survival and disease-free survival 71 dMMR cases were divided into CIMP+ group (n=43) and CIMP-group (n=28), and the K-M curves were plotted to analyze the differences in overall survival (OS) and disease free survival (DFS). Comparisons between groups were performed by t-test, χ2 test or Mann-Whitney U nonparametric test, and the difference in survival curves was tested by Long-rank test. Results Patients in the CIMP+ group were significantly older than those in the CIMP-group [(70.84±12.60) years vs (66.21±13.08) years, t=3.18, P=0.002]. Right colon tumors originating from the CIMP+ molecular pathway were 9.3 times more likely to be CIMP+ than those of the left colon cancers (OR=9.3, 95%CI: 5.2-17.9). BRAF mutant colon cancer originating from CIMP+ was 215.2 times more common than BRAF wild-type colon cancer originating with CIMP+ (OR=215.2, 95%CI: 53.2-1906.7) and patients with dMMR colon cancer originated 12.8 times more common than patients with pMMR (OR=12.8, 95%CI: 7.0-23.9). The difference between the CIMP+ and CIMP-groups was not statistically significant in terms of overall survival and disease-free survival (P=0.590, 0.220). In the dMMR colon cancer subgroup, CIMP status did not correlate with patients′ overall survival and disease-free survival (P>0.05). Conclusions CIMP+ colon cancer patients were mostly of advanced age, with tumors originating from the right colon, mostly combined with BRAF gene mutations, and manifested as mismatch repair-deficient colon cancers. CIMP status had no correlation with TNM stage and survival of colon cancers patients. There was no significant difference in the survival between dMMR colon cancers caused by CIMP+ and those caused by MMR gene mutations.

    结肠肿瘤基因突变CpG岛甲基化错配修复功能缺失

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    腹腔镜近端胃大部切除术与远端胃大部切除术治疗胃癌的疗效及安全性分析

    刘罗海李仕青
    37-43页
    查看更多>>摘要：目的 探讨腹腔镜技术在行近端胃大部切除术与远端胃大部切除术中2种手术方式治疗胃癌的疗效及安全性研究。 方法 回顾性分析淮南东方医院集团总医院普外科2016年1月—2020年1月期间收治的98例胃癌患者的临床资料，其中男性71例，女性27例，年龄32～80岁，平均年龄(62.03±10.6)岁。根据手术方式不同分为近端组(n＝28)和远端组(n＝70)。近端组采用腹腔镜近端胃大部切除术治疗，远端组采用腹腔镜远端胃大部切除术治疗。采用SPSS 20.0软件分析两组手术相关临床指标、术后并发症、营养状况、生存质量及生存率之间的差异，采用Kaplan-Merier绘制生存曲线，两组生存差异比较采用Log-rank检验。 结果 近端组淋巴结清扫数目少于远端组，差异有统计学意义(t＝2.02，P＝0.045)；近端组反流性食管炎发病率高于远端组(57.14%比4.29%，χ2＝35.75，P<0.001)，反流性胃炎发病率则低于远端组，差异有统计学意义(3.57%比22.86%，P＝0.035)；术后近端组红细胞、血红蛋白及白蛋白水平均低于远端组，差异有统计学意义(t＝2.62，P＝0.010；t＝2.12，P＝0.036；t＝3.54，P＝0.001)；术后1个月，近端组Karnofsky功能状态评分低于远端组，差异有统计学意义(t＝2.27，P＝0.025)；近端组术后1、3、5年生存率分别为85.71%、64.29%、46.43%，远端组术后1、3、5年生存率分别为88.57%、71.43%、57.14%，两组生存曲线比较，差异无统计学意义(P>0.05)。 结论 腹腔镜近端胃大部切除术后并发反流性食管炎发病率高于远端胃大部切除术，且术中清扫淋巴结数目少于远端胃大部切除组，与腹腔镜远端胃大部切除术相比近端胃大部切除术患者术后营养状况明显较差，但两组远期生存率无明显差异。 Objective To explore the efficacy and safety of laparoscopic technology in the treatment of gastric cancer which using proximal subtotal gastrectomy and distal subtotal gastrectomy. Methods A retrospective analysis was conducted on the clinical data of 98 gastric cancer patients admitted to the Department of General Surgery, General Hospital of Huainan Eastern Hospital Group from January 2016 to January 2020, including 71 males and 27 females with an average age of (62.03±10.6) years old(ranged from 32 to 80 years). All cases were divided into proximal group (n=28) and distal group (n=70) according to different surgical methods. The proximal group was treated with laparoscopic proximal subtotal gastrectomy, while the distal group was treated with laparoscopic distal subtotal gastrectomy. SPSS 20.0 software was used to analyze the differences in surgical related clinical indicators, postoperative complications, nutritional status, quality of life, and survival rate between two groups. Kaplan-Merier was used to draw survival curves, and Log-rank test was used to compare the survival differences between the two groups. Results The number of lymph node dissection in the proximal group was less than that in the distal group, and the difference was statistically significant (t=2.02, P=0.045). The incidence rate of reflux esophagitis in the proximal group was higher than that in the distal group (57.14% vs 4.29%, χ2=35.75, P<0.001), the incidence rate of reflux gastritis was lower than that of the distal group, the difference was statistically significant(3.57%vs 22.86% P=0.035). The levels of red blood cells, hemoglobin, and albumin in the proximal group were lower than those in the distal group after surgery, and the differences were statistically significant (t=2.62, P=0.010 t=2.12, P=0.036 t=3.54, P=0.001). One month after surgery, the Karnofsky functional status score in the proximal group was lower than that in the distal group, and the difference was statistically significant (t=2.27, P=0.025). The postoperative 1, 3, and 5-year survival rates of the proximal group were 85.71%, 64.29%, and 46.43%, respectively, while the postoperative 1, 3, and 5-year survival rates of the distal group were 88.57%, 71.43%, and 57.14%, respectively. There was no statistically significant difference in the survival curves between the two groups (P>0.05). Conclusions The incidence rate of reflux esophagitis after laparoscopic proximal subtotal gastrectomy is higher than that of distal subtotal gastrectomy, and the number of lymph nodes cleared during operation is less than that of distal subtotal gastrectomy. Compared with laparoscopic distal subtotal gastrectomy, the nutritional status of patients after proximal subtotal gastrectomy is significantly worse, but there is no significant difference in long-term survival rate between the two groups.

    腹腔镜胃切除术胃肿瘤胃近端胃食管反流手术后并发症淋巴结

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    不同温度灌洗液对输尿管软镜下钬激光碎石术后寒战及炎性反应的影响分析

    辛锋刘久华范利
    43-48页
    查看更多>>摘要：目的 探讨等体温(37 ℃)、等室温(24 ℃)及冷液体(20 ℃)3种温度的灌洗液对输尿管软镜下钬激光碎石术后寒战及炎性反应的影响。 方法 选取连云港市第二人民医院2020年7月—2023年7月收治的132例接受输尿管软镜下钬激光碎石术患者的病历资料，根据术中灌洗液温度分为冷液体组(20 ℃，n＝44)、等室温组(24 ℃，n＝44)和等体温组(37 ℃，n＝44)，采用方差分析三组手术10 min、30 min、术毕即刻核心体温、手术前后应激反炎性反应，采用χ2检对比三组术后寒战发生情况。 结果 三组患者手术10 min、30 min、术毕即刻核心体温对比差异具有统计学意义，冷液体组上述时间点核心体温较等室温组、等体温组低(P<0.05)，而等室温组和等体温组术中10 min、30 min、术毕即刻核心体温对比差异无统计学意义(P>0.05)；三组术后甲肾上腺素、血清皮质醇水平较术前升高，冷液体组较等室温组和等体温组高(P<0.05)，但等室温组和等体温组两组术后对比差异无统计学意义(P>0.05)；三组术后C反应蛋白、白细胞介素-10、白细胞水平较术前升高，但各组间术后对比差异无统计学意义(P>0.05)；三组术后寒战发生率对比差异具有统计学意义(χ2＝6.87，P＝0.030)，术后冷体液组寒战发生9例，寒战发病率最高为20.45%，等室温组寒战3例，等体温组寒战2例，寒战发病率(6.81%比4.55%)对比差异无统计学意义(P>0.05)。 结论 在输尿管软镜下钬激光碎石术中，与冷液体灌洗液相比，术中采用等室温灌洗液和等体温灌洗液能维持患者术中体温恒定，减轻应激反应，术后炎性反应轻且术后寒战发生率低。 Objective To investigate the effects of constant body temperature (37 ℃), constant room temperature (24 ℃) and cold liquid (20 ℃) on shivering and inflammatory response after holmium laser lithotripsy under ureteroscope. Methods A total of 132 patients receiving holmium laser lithotripsia under ureteroscope treated in the Second People′s Hospital of Lianyungang City from July 2020 to July 2023 were selected as the study objects. According to the intraoperative lavage fluid temperature, they were divided into cold liquid group (20 ℃, n=44), equal room temperature group (24 ℃, n=44) and equal body temperature group (37 ℃, n=44).. Anova was used to compare the occurrence of postoperative chills in the three groups at 10 min, 30 min, immediately after the operation, and the anti-inflammatory response of stress before and after the operation. Chi-square test was used to compare the occurrence of postoperative chills. Results The difference of core body temperature between the three groups at 10 min, 30 min and immediately after operation was statistically significant. The core body temperature of the cold liquid group was lower than that of the equal room temperature group and the equal body temperature group at the above time point (P<0.05). There was no significant difference in core body temperature between the isoroom temperature group and the isobody temperature group at 10 min, 30 min and immediately after operation (P>0.05)..The levels of norepinephrine and serum cortisol in the three groups were higher after surgery than before surgery, and the levels in the cold liquid group were higher than those in the isothermal group and the isothermal group (P<0.05), but there was no statistical significance between the isothermal group and the isothermal group (P>0.05).The levels of C-reactive protein, interleukin-10 and white blood cells were higher after operation than before operation, but there was no statistical significance among the three groups (P>0.05).There was a statistically significant difference in the incidence of postoperative chills among the three groups (χ2=6.87, P=0.03). Nine cases of postoperative chills occurred in the cold body fluid group, the highest incidence of chills was 20.45%, 3 cases occurred in the room temperature group, and 2 cases occurred in the body temperature group. There was no significant difference in the incidence of chills (6.81% vs 4.55%) (P>0.05). Conclusion In holmium laser lithotripsy under ureteroscope, compared with cold liquid lavage, intraoperative equi-room temperature lavage and equi-body temperature lavage can maintain constant intraoperative body temperature, relieve stress reaction, reduce postoperative inflammatory reaction and lower incidence of postoperative chills.

    温度碎石术,激光寒战输尿管软镜

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