The Study And Application Of Laparoscopic Radical Total Gastrectomy In Upper Gastric Carcinoma

Background:Gastric cancer is one of the most common human malignant tumor. Upper gastric cancer is a special type of gastric cancer. The treament effects of upper gastric cancer isn’t ideal because of the untypical symptoms and the unknown degree of disease. At preasent, radical resection operation is one of the main treatment methods in patients with upper gastric cancers. The operation mode of upper gastric cancer is divided into radical total gastrectomy and radical proximal gastrectomy. Previous study show that the treatment efficacy of different operation mode has slightly different. In recent years, laparoscopic radical gastrectomy for gastric cancer has been widely used in clinical. But, because of the high difficulty technical of laparoscopic radical gastrectomy. So, there are lots of study about the laparoscopic radical proximal subtotal gastrectomy, but little known about the laparoscopic total gastrectomy in gastric carcinoma. Presently, the operation type of patients with upper gastric cancer has become a hot spot. There are some argument about that how to choose a more reasonable operation method and digestive tract reconstruction, how to reduce the postoperative complications and how to improve the quality of live. Since2011, patients with upper gastric cancer underwent laparoscopic total gastrectomy in our department. Thirty-nine patients with upper gastric carcinoma underment laparoscopic total gastrectomy were collected and retrospectively analysed from2011.1-2012.1in our department. Forty-seven patients with upper gastric carcinoma underment laparoscopic proximal gastric were collected and retrospectively analysed from2011.1-2012.1in general hospital of LanZhou command of PLA.Objective To explore the safety, feasibility and therapeutic results of total gastrectomy and radical proximal subtotal gastrectomy and to summarize the operation experence and skill. Methods:Inclusion and exclusion criteria were formulated. Clinical data of patients with upper gastric cancer were collected and retrospective analysed at the Department of general surgery, Lanzhou General Hospital of Lanzhou military region from2010January to2012January. In our study, all patients were divided into two groups:laparoscopic radical gastrectomy(A group) and laparoscopic radical proximal subtotal gastrectomy (B group). Operation time, lymph node ratio and postoperative complication were observated and statistical analysed in two group.Results:In our study,86patients with upper gastric cancer were collected according to the inclusion and exclusion criteria. All patients were divided into two group:39cases of laparoscopic radical gastrectomy (A group), laparoscopic radical proximal subtotal gastrectomy in47cases (group B). There was no significant difference in gender, age, BMI index, preoperative ASA classification and postoperative pathological staging in two groups. Two groups of patients were successfully curved and discharged. Lymph node rate in A group was was significantly higher than that in B group. Our data shows that A group was higher than B group in operation time. But, there were no significant statistically in postoperative anastomosis fistula, bleeding, abdominal infection, lung infection and other complications in two group. Through our study, we found that A group has obviously effective in anti reflux.Conclusions:Taken together, our findings indicated that Laparoscopic radical total gastrectomy for gastric cancer have some obvious advantages such as:lower postoperative complications, anti reflux effect, and minimally invasive advantages, higher lymph node dissection rate and so on. So, Laparoscopic radical total gastrectomy for gastric cancer is worth the clinical promoted application. Objective:To compare the effect on immune function of laparoscopic and open gastric cancer radical surgery.Methods:100cases of advanced gastric cancer patients were collected at the Department of general surgery, Lanzhou General Hospital of Lanzhou military region and the the first hospital of LanZhou university from2012.6-2013.4. All patients were randomly divided into two groups:A group (laparoscopic operation group) and group B (open operation group). There are50cases in each group. In our study, we aim to compare the postoperative changes of immune function between the two groups.Results:Two groups of patients were successfully curved and discharged. Our data show that the level of C3, C4, IgG, IgA and IgM in blood have been obviously inhabited in24,72hours after operation. After72hours, the immune function gradully recovered. Through our study, our research found that the immune function changs smoothly after operation in laparoscopic group. But, the immune function was obviously inhabited in open group after operation. The level of CRP in two groups of patients were increased after surgery. Notably, we found that the level of CRP increased more significantly in the open group than laparoscopic group. There are some significant statistically.Conclusion:Taken together, our data indicated that Laparoscopic radical total gastrectomy for gastric cancer have some obvious advantages such as:lower effect on immune function, lower injury.