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腹腔镜全胃切除术淋巴结清扫范围与策略

中华普外科手术学杂志（电子版） 2024年第2期18卷 127-130页

作者：李乐平肖琨张荣华商亮靖昌庆山东大学省立医院济南250021

随着精准诊疗和微创理念的发展,胃癌的治疗策略逐渐多样化、精细化,但对于进展期胃癌患者,根治性的手术切除仍是其治疗过程中的关键。随着腹腔镜技术的推广应用,腹腔镜全胃切除术在全国三级医院均广泛开展,所以只有形成一套详细完整的... 详细信息

随着精准诊疗和微创理念的发展,胃癌的治疗策略逐渐多样化、精细化,但对于进展期胃癌患者,根治性的手术切除仍是其治疗过程中的关键。随着腹腔镜技术的推广应用,腹腔镜全胃切除术在全国三级医院均广泛开展,所以只有形成一套详细完整的胃癌手术淋巴结清扫策略,才能成为各医院开展腹腔镜胃癌手术的质量保障。腹腔镜全胃切除术需要在胃周进行多层次、多间隙的分离与解剖,要精准的裸化离断胃周血管,并彻底地清扫胃周淋巴结,才能保障手术的根治性。通常将胃周淋巴结的清扫分为幽门下区域、胰腺上区域、幽门上区域、脾门区域和贲门区域等五个区域。清扫各个区域的过程中需要术者、助手和扶镜手默契配合,才能保障腹腔镜全胃切除术淋巴结清扫的顺利进行。

关键词：胃肿瘤胃切除术腹腔镜淋巴结清扫术

新辅助放疗联合免疫治疗在局部进展期直肠癌中的研究进展

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老年医学研究 2024年第1期5卷 62-67页

作者：王明非商亮种微田锋李乐平靖昌庆山东大学山东济南250012 山东省立医院胃肠外科山东济南250021 山东第一医科大学附属省立医院胃肠外科山东济南250021

随着新辅助治疗发展不断成熟,免疫检查点抑制剂(ICIs)应用于局部进展期直肠癌(LARC)已取得了可喜的突破。相较单纯新辅助放疗及单纯免疫治疗,新辅助放疗联合免疫治疗方案展现出更好的临床及病理完全缓解率。但就具体治疗方案,学界还未... 详细信息

随着新辅助治疗发展不断成熟,免疫检查点抑制剂(ICIs)应用于局部进展期直肠癌(LARC)已取得了可喜的突破。相较单纯新辅助放疗及单纯免疫治疗,新辅助放疗联合免疫治疗方案展现出更好的临床及病理完全缓解率。但就具体治疗方案,学界还未达成共识。本文介绍了新辅助放疗联合免疫治疗在LARC中应用的代表性试验结果及最新临床研究,对治疗方案中放疗的具体剂量及分割方式、免疫治疗的周期及联合新辅助放疗的先后顺序、新辅助治疗结束后手术间隔及术后进行辅助治疗与否等关键技术问题进行了归纳总结。从免疫浸润、远隔效应及肠道菌群三个方向对近年来放疗增敏免疫治疗的具体作用机制探索做了系统梳理,同时回顾了可预测新辅助放疗联合免疫治疗在LARC中疗效的标志物研究进展,希望能为LARC临床治疗方案的选择及未来临床研究的设计提供参考与方向。

关键词：直肠癌局部进展期直肠癌新辅助放疗免疫治疗新辅助放疗联合免疫治疗

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右半结肠癌微创术式的选择

中华胃肠外科杂志 2017年第5期20卷 504-506页

作者：靖昌庆山东大学附属省立医院胃肠外科济南250021

腹腔镜手术已成为右半结肠切除的标准手术方式，目前已发展成为包括常规腹腔镜手术、手辅助腹腔镜手术、单孔腹腔镜手术、经自然腔道内镜外科手术和机器人手术等多种方式。如何选择合理的手术方式有时会非常令人困惑。对患者来说，手术... 详细信息

腹腔镜手术已成为右半结肠切除的标准手术方式，目前已发展成为包括常规腹腔镜手术、手辅助腹腔镜手术、单孔腹腔镜手术、经自然腔道内镜外科手术和机器人手术等多种方式。如何选择合理的手术方式有时会非常令人困惑。对患者来说，手术的安全、便宜、根治至关重要；对医生来讲，还要兼顾手术技术的先进性和简便性。我们如何选择对两者双赢的手术方式呢？常规腹腔镜手术方式是所有微创手术方式的基础，完整结肠系膜切除和D3淋巴结清扫是右半结肠癌手术重要的技术基础。手辅助腹腔镜手术对于肥胖、腹腔内严重粘连和肠梗阻的患者有一定优势。单孔腹腔镜手术和经自然腔道手术具有最小化的腹壁创伤，有利于术后康复，但有一定技术难度，尤其是经自然腔道手术难度最大。机器人手术虽然硬件设备先进，但昂贵的价格限制了其推广使用。我们应该综合考虑医生的腹腔镜技术水平、医院的设备情况、患者的病情及经济状况等多方面因素，选择合理的右半结肠腹腔镜手术方式。

关键词：结肠肿瘤右半结肠右半结肠切除术微创手术

Hypoxia-inducible factor-lαand semaphorin4D genes involved with tumor-associated macrophage-induced metastatic behavior and clinical significance in colon cancer

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Chinese Medical Journal 2014年第20期 3568-3575页

作者： Mu Linjun Wang Jinshen Chen Yuezhi Li Leping Guo Xiaobo Zheng Sheng jing changqing Department of Gastrointestinal Surgery Shandong Provincial Hospitalaffiliated to Shandong University Jinan Shandong 250021 China

Background Hypoxia promotes tumor angiogenesis and hypoxia-inducible factor-1 alpha （HIF-lg） plays a pivotal role in this process. Recently identified pro-angiogenic factor, semaphorin4D （Sema4D） also promotes angiogenesis and enhances invasive proliferation in some tumors. Furthermore, tumor-associated macrophages （TAMs） can increase the expression of HIF-la and Sema4D in cancer cells and thus influence tumor growth and progression. The purpose of this study was to evaluate the effect of TAMs on the expression of Sema4D and HIF-la and the impact of biologic behavior in colon cancer cells. Methods Immunohistochemistry was used to analyze HIF-la and Sema4D expression in 86 curatively resected colon cancer samples and 52 normal colon tissues samples. The relationship between their expression and clinicopathological factors was analyzed. Furthermore, macrophage-tumor cell interactions, such as metastasis, angiogenesis, were also studied using in vitro co-culture systems. Statistical analysis was performed using SPSS 17.0 software （SPSS Inc., USA）. Differences between two groups were analyzed with Student＇s t test. Results HIF-la （58%） and Sema4D （60%） were expressed at a significantly higher level in tumors than in normal tissues （P 〈0.01, for both）. Furthermore, HIF-la and Sema4D expression was significantly correlated with lymphatic metastasis, specific histological types and TNM stages （P 〈0.05）, but not with age and tumor size （P 〉0.05）. Sema4D expression was correlated with that of HIF-la （r=0.567, P 〈0.01）. TAMs markedly induced HIF-la and Sema4D expression in colon cancer calls and subsequently increased their migration and invasion. Conclusions HIF-la and Sema4D expression are closely related to lymphatic metastasis, specific histological types and TNM stages in colon cancer. Furthermore, TAMs promote migration and invasion of colon cancer cells and endothelial tube formation, possibly through up-regulation of HIF-la and Sema4D.

关键词： colon cancer hypoxia-inducible factor-1 alpha semaphorin4D tumor-associated macrophages metastasis

Hypoxia-inducible factor-1α and semaphorin4D genes involved with tumor-associated macrophage-induced metastatic behavior and clinical significance in colon cancer

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中华医学杂志(英文版) 2014年第20期127卷 3568-3575页

作者： Mu Linjun Wang Jinshen Chen Yuezhi Li Leping Guo Xiaobo Zheng Sheng jing changqing Department of Gastrointestinal Surgery Shandong Provincial Hospital affiliated to Shandong University

Background Hypoxia promotes tumor angiogenesis and hypoxia-inducible factor-1 alpha(HIF-1α) plays a pivotal role in this process. Recently identified pro-angiogenic factor, semaphorin4D(Sema4D) also promotes angiogenesis and enhances invasive proliferation in some tumors. Furthermore, tumor-associated macrophages(TAMs) can increase the expression of HIF-1α and Sema4 D in cancer cells and thus influence tumor growth and progression. The purpose of this study was to evaluate the effect of TAMs on the expression of Sema4 D and HIF-1α and the impact of biologic behavior in colon cancer cells. Methods Immunohistochemistry was used to analyze HIF-1α and Sema4 D expression in 86 curatively resected colon cancer samples and 52 normal colon tissues samples. The relationship between their expression and clinicopathological factors was analyzed. Furthermore, macrophage-tumor cell interactions, such as metastasis, angiogenesis, were also studied using in vitro co-culture systems. Statistical analysis was performed using SPSS 17.0 software(SPSS Inc., USA). Differences between two groups were analyzed with Student's t test. Results HIF-1α(58%) and Sema4D(60%) were expressed at a significantly higher level in tumors than in normal tissues(P 0.05). Sema4 D expression was correlated with that of HIF-1α(r=0.567, P <0.01). TAMs markedly induced HIF-1α and Sema4 D expression in colon cancer cells and subsequently increased their migration and invasion. Conclusions HIF-1α and Sema4 D expression are closely related to lymphatic metastasis, specific histological types and TNM stages in colon cancer. Furthermore, TAMs promote migration and invasion of colon cancer cells and endothelial tube formation, possibly through up-regulation of HIF-1α and Sema4 D.

关键词： colon cancer hypoxia-inducible factor-1 alpha semaphorin4D tumor-associated macrophages metastasis

Comparing the effects of Bassini versus tension-freehernioplasty: 3 years’ follow-up

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Frontiers of Medicine 2010年第4期4卷 463-468页

作者： Yulong SHI Zhongxue SU Leping LI Hongjun LIU changqing jing Division of Gastrointestinal Surgery Affiliated Provincial Hospital of Shandong UniversityJinwu Road 324Jinan 250021China

In order to compare the effects of Bassini and tension-free mesh hernioplasty,a total of 552 patients with inguinal hernia who were subjected to surgical treatment in our hospital were randomly divided into the following two groups:the Bassini group(n=269)and the tension-free mesh group(n=283).The recurrence rates,pain,dis-comfort,and other complications were recorded,and the causes of the complications were *** recurrence rate in the Bassini group was 8.9%(24/269),signiﬁcantly higher than that in the tension-free repair group(2.8%,8/283).In addition,the recurrence rates in the Bassini and tension-free groups before 2004 were 12.6%and 5.6%,respectively,which were markedly higher than the rates after 2004(5.3%and 0.7%,respectively).The rate of post-operative discomfort and pain within theﬁrst three months was higher in the Bassini group compared to the tension-free group(25.7%vs 18.5%,respectively).However,there was no difference after three months in the rate of post-operative discomfort and pain,incidence of infection,or scrotal edema between the two *** average hospital stay in the Bassini group was longer than that in the tension-free repair group(7.6�1.2 vs 4.5�2.2 days,respectively),but the cost was lower(4518.0�510 vs 6221.3�578 yuan,respectively).Thus,tension-free mesh hernioplasty is indicated for most inguinal hernia patients due to the low recurrence rate,rapid recovery time,and treatment success,but the traditional Bassini procedure has lower cost and other beneﬁcial effects and is still suitable for some patients.

关键词： hernioplasty Bassini repair tension-free repair complication

STUDY OF SUPERSTRUCTURE Ⅱ IN MULTIFERROIC BiMnO3 BY IMAGE DECONVOLUTION

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STUDY OF SUPERSTRUCTURE Ⅱ IN MULTIFERROIC BiMnO3 BY IMAGE D...

加速康复外科在胃肠外科应用中循证医学的重要作用

第十二届北京分析测试学术报告会暨展览会(BCEIA 2007)

作者： Binghui GE Yumei WANG Fanghua LI Zhenhua CHI changqing jing Beijing National Laboratory for Condensed Matter Physics Institute of Physics Chinese Academy of Sciences

Multifferoic materials possessing both ferromagnetism and ferroelectricity have recently attracted growing interest because of their special physical properties and potential technique *** MnO is one of the extensively studied *** far two types of superstructure were found in Bi MnO,and the substructure is of the distorted perovskite type with the Mn and Bi atoms situated at the body center and the vertex of the unit cell,respectively,and O

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山东大学学报（医学版） 2019年第9期57卷 18-23页

作者：靖昌庆王金申山东大学附属省立医院胃肠外科

加速康复外科(ERAS)在相关学术组织的推动下,目前在胃肠外科已广泛开展,确实为临床治疗带来了巨大益处,也节约了医疗卫生资源,但加速康复外科的目标是使患者更好恢复而非更快,实现这一目标的根基是循证医学证据,因此在胃肠外科推广应用E... 详细信息

加速康复外科(ERAS)在相关学术组织的推动下,目前在胃肠外科已广泛开展,确实为临床治疗带来了巨大益处,也节约了医疗卫生资源,但加速康复外科的目标是使患者更好恢复而非更快,实现这一目标的根基是循证医学证据,因此在胃肠外科推广应用ERAS的过程中需要重视临床研究工作,从而提供高质量的循证医学证据。

关键词：加速康复外科胃肠外科循证医学

一项基于全国多中心前瞻性登记队列研究(PACAGE)的中国胃癌和结直肠癌患者术后并发症现状分析

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中华胃肠外科杂志 2024年第3期27卷 247-260页

作者：张书勤吴舟桥霍博文徐惠宁赵康靖昌庆刘凤林余江李正荣张健臧潞蒿汉坤郑朝辉李勇樊林黄华梁品吴斌朱甲明牛兆建朱玲华宋武尤俊燕速李子禹青海大学医学部公共卫生系青海大学附属医院西宁810001 北京大学肿瘤医院胃肠肿瘤中心北京100142 青海大学附属医院胃肠肿瘤外科西宁810001 山东第一医科大学附属省立医院胃肠外科济南250021 复旦大学附属肿瘤医院胃外科上海200025 南方医科大学附属南方医院普通外科广州510515 南昌大学附属第一医院胃肠外科南昌330006 浙江大学附属第一医院胃肠外科杭州310003 上海交通大学医学院附属瑞金医院胃肠外科上海200025 复旦大学附属华山医院胃肠外科上海200040 福建医科大学附属协和医院胃外科福州350001 广东省人民医院胃肠外科广州510080 西安交通大学附属第一医院普通外科西安710061 大连医科大学附属第一医院胃肠外科大连116011 中国协和医科大学附属协和医院基本外科北京100032 中国医科大学第一附属医院胃肠肿瘤外科沈阳110002 青岛大学附属医院胃肠外科青岛266000 浙江大学附属邵逸夫医院胃肠外科杭州310009 中山大学第一附属医院胃肠外科广州510062 厦门大学第一附属医院胃肠肿瘤外科厦门361003 徐州医科大学附属宿迁医院感染管理科

目的探讨我国胃癌和结直肠癌患者术后并发症的发生率,并评估其危险因素。方法本研究采用全国多中心前瞻性数据登记队列研究方法,数据来自中国胃肠肿瘤外科联盟发起的胃肠外科手术后腹部并发症现状研究数据库(PACAGE)。PACAGE数据库自201... 详细信息

目的探讨我国胃癌和结直肠癌患者术后并发症的发生率,并评估其危险因素。方法本研究采用全国多中心前瞻性数据登记队列研究方法,数据来自中国胃肠肿瘤外科联盟发起的胃肠外科手术后腹部并发症现状研究数据库(PACAGE)。PACAGE数据库自2018年12月至2020年12月期间,前瞻性收集了20家医学中心胃癌和结直肠癌患者一般人口统计学数据、围手术期治疗及术后并发症相关数据,根据是否发生术后并发症进行分组,参照胃肠肿瘤外科术后并发症相关专家共识和Clavien-Dindo分级标准,对并发症进行分类及分级。通过绘制热图,将不同分级的术后并发症发生率可视化;采用多因素非条件logistic回归模型,分析发生术后并发症的独立危险因素。结果共纳入3926例胃癌和结直肠癌患者,657例患者共发生876例次术后并发症,总体并发症发生率16.7%(657/3926),Ⅲ级及以上严重并发症发生率4.0%(156/3926),Ⅴ级并发症发生率0.2%(7/3926)。胃癌患者2271例,术后并发症发生率18.1%(412/2271),严重并发症发生率4.7%(106/2271);结直肠癌患者1655例,术后并发症发生率14.8%(245/1655),严重并发症发生率3.0%(50/1655)。胃癌和结直肠癌患者吻合口漏的发生率分别是3.3%(74/2271)和3.4%(56/1655)。腹腔感染在各类并发症中占比最高,在胃癌和结直肠癌患者中分别为28.7%(164/572)和39.5%(120/304)。在所有术后并发症严重程度分级中,Ⅱ级并发症占比最高,胃癌和结直肠癌分别占65.4%(374/572)和56.6%(172/304)。多因素分析显示:(1)胃癌组患者发生术后并发症的独立影响因素包括:有术前合并症(OR=2.54,95%CI:1.51~4.28,P180 min(OR=1.81,95%CI:1.42~2.31,P50 ml(OR=1.29,95%CI:1.01~1.63,P=0.038)和相比于全胃切除术的远端胃切除(OR=0.65,95%CI:0.51~0.83,P<0.001);(2)肠癌组患者发生术后并发症的独立影响因素包括:女性(OR=0.60,95%CI:0.44~0.80,P<0.001)、有术前合并症(OR=2.73,95%CI:1.25~5.99,P=0.030)、接受新辅助治疗(OR=1.83,95%CI:1.23~2.72,P=0.008)、腹腔镜手术(OR=0.47,95%CI:0.30~0.72,P=0.022)和相比于低位前切术的腹会阴联合切术(OR=2.74,95%CI:1.71~4.41,P<0.001)。结论胃癌和结直肠癌患者术后各类感染相关的并发症最为常见,虽然两者术后发生并发症的危险因素各有不同,但有术前合并症、行新辅助治疗以及手术切除范围,是胃癌和结直肠癌患者术后发生并发症的共同影响因素。

关键词：胃肿瘤结直肠肿瘤术后并发症风险因素