...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Surgical Endoscopy >Laparoscopic gatrojejunostomy for palliation of gastric outlet obstruction in unresectable gastric cancer.
【24h】

Laparoscopic gatrojejunostomy for palliation of gastric outlet obstruction in unresectable gastric cancer.

机译：腹腔镜空肠吻合术可缓解无法切除的胃癌的胃出口梗阻。

获取原文
获取原文并翻译 | 示例
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

BACKGROUND: Gastric bypass through laparotomy is required traditionally when gastric outlet obstruction occurs secondary to a disease process (e.g., unresectable cancer). The recent trend toward minimally invasive procedures has led us to apply laparoscopic bypass surgery for gastric obstruction caused by unresectable advanced gastric cancer. METHODS: From March 1998 to February 2000, 78 gastrojejunostomies (GJ) (45 open [OGJ] and 33 laparoscopic [LGJ] procedures) were performed for palliation of gastric outlet obstruction caused by advanced gastric, duodenal, papilla of vater, and pancreatic cancers at the Asan Medical Center. In 68 patients with advanced gastric cancer, OGJ (n = 38) and LGJ (n = 30) were performed. Of these, 10 OGJ patients were compared with 10 diagnosis-matched LGJ control subjects who underwent surgery during the same period in terms of age, gender, American Society of Anesthesiology (ASA) grading, previous abdominal surgery, operating time, time to oral food intake, pain-killer consumption, postoperative hospital stay, immune response, morbidity, and mortality. Immune parameters including serum white blood cells (WBC) count, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), cortisol, and erythrocyte sedimentation rate (ESR) levels were assessed preoperatively and on postoperative days 1 and 3 between the two groups. With the patients under the general endotracheal anesthesia, we applied an upper midline incision in OGJ and inserted four trocars in LGJ. Side-to-side gastrojejunostomy was performed in a standard fashion. In LGJ, intracorporeal suture using 2-0 vicryl was performed to repair the gastrotomy and jejunotomy site after gastrojejunostomy using a 30-mm or 45-mm Endo-GIA stapler. RESULTS: There were no significant differences between OGJ and LGJ in terms of gender, age, ASA grading, and previous abdominal surgery. In OGJ, antecolic isoperistaltic GJ was performed in 10 cases, but 8 antecolic and 2 retrocolic approaches were performed in LGJ with no conversion to open surgery. Operating time (113.5 +/- 11.2 vs 100.5 +/- 9.8 min), pain-killer consumption (540 +/- 123.2 vs 430 +/- 58.2 mg), and postoperative hospital stay (12.5 +/- 3.9 vs 8.5 +/- 2.9 days) were reported, respectively. Serum WBC and cortisol levels were slightly increased in both groups preoperatively and on postoperative days 1 and 3. Serum ESR, TNF-alpha, and IL-6 levels were significantly increased in the OGJ patients. Postoperative complications (9 with OGJ and 2 with LGJ) and postoperative death (1 in each group) occurred. During the follow-up period (3-23 months), there was one case of readmission in each group because of anemia and generalized pain. CONCLUSIONS: Laparoscopic GJ for the palliation of unresectable advanced gastric cancer can achieve excellent results with less suppression of immune function, lower morbidity, greater improvement of hemodynamic activities, and earlier recovery of bowel movements than OGJ.
机译：背景：传统上，当疾病过程继发于胃出口阻塞（例如不可切除的癌症）时，传统上需要通过剖腹术进行胃旁路手术。微创手术的最新趋势使我们对无法切除的晚期胃癌所致的胃梗阻应用腹腔镜旁路手术。方法：从1998年3月至2000年2月，进行了78例胃空肠切开术（45例开放式[OGJ]和33例腹腔镜[LGJ]手术），以缓解因晚期胃癌，十二指肠癌，化脓性乳头癌和胰腺癌引起的胃出口梗阻在牙山医疗中心在68例晚期胃癌患者中，进行了OGJ（n = 38）和LGJ（n = 30）。在这些患者中，将10例OGJ患者与10例经诊断匹配的LGJ对照受试者进行了比较，这些受试者在同一时期接受了手术，包括年龄，性别，美国麻醉学会（ASA）分级，以前的腹部手术，手术时间，口服食物的时间摄入量，止痛药的消耗量，术后住院时间，免疫反应，发病率和死亡率。术前和术后1天评估血清白细胞（WBC）计数，肿瘤坏死因子-α（TNF-α），白细胞介素6（IL-6），皮质醇和红细胞沉降率（ESR）水平的免疫参数。和两组之间的3。对于在气管内全麻下的患者，我们在OGJ处上中线切开切口，并在LGJ中插入四根套管针。并排胃空肠吻合术以标准方式进行。在LGJ中，使用30mm或45mm Endo-GIA吻合器在进行空肠吻合术后使用2-0 vicryl进行体内缝合以修复胃切除术和空肠切开术部位。结果：在性别，年龄，ASA分级和先前的腹部手术方面，OGJ和LGJ之间无显着差异。在OGJ中，有10例进行了前庭等手术GJ，但在LGJ中进行了8例前肠切除术和2例逆行结肠切除术，未转换为开放手术。手术时间（113.5 +/- 11.2 vs 100.5 +/- 9.8分钟），止痛药的消耗量（540 +/- 123.2 vs 430 +/- 58.2 mg）和术后住院时间（12.5 +/- 3.9 vs 8.5 + / -2.9天）。两组患者术前和术后第1、3天的血清白细胞和皮质醇水平均略有升高。OGJ患者的血清ESR，TNF-α和IL-6水平显着升高。发生术后并发症（OGJ 9例，LGJ 2例）和术后死亡（每组1例）。在随访期间（3-23个月），由于贫血和全身疼痛，每组中有1例再次入院。结论：与OGJ相比，腹腔镜GJ可以缓解无法切除的晚期胃癌，取得了优异的结果，免疫功能受到抑制的可能性更低，发病率更低，血液动力学活动的改善更大，肠蠕动的恢复也更快。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号