2018年 · 第56卷第08期

Severe reflux esophagitis may occur after simple esophagogastric anastomosis^[1]。 Therefore, some scholars have proposed a variety of improved esophagogastric anastomosis methods against reflux on the basis of proximal gastrectomy. However, no anastomosis has been widely accepted at present. In 2016, Japanese scholar Yamashita designed and first reported esophagogastric side-overlap anastomosis for digestive tract reconstruction after total laparoscopic proximal gastrectomy, believing that it can effectively reduce the incidence of reflux esophagitis and anastomotic stenosis after proximal gastrectomy^[2]。 The gastric surgery department of our hospital carried out this technique in March 2017, and as of October 2017, 8 cases of total laparoscopic esophagogastric side-overlap anastomosis were completed. The preliminary experience of the feasibility, safety and short-term efficacy of this procedure is reported below.

The common pathological types of pancreatic serous cystadenoma (SCN) include microcystic type, oligocystic type, solid type and mixed type, among which serous microcystic adenoma (SMA) is the most common subtype, accounting for about 45%^[1]。 SMA has low malignant potential and good prognosis. Most of the diagnosed SMA do not need special treatment and can be followed up and observed^[2]。 Most patients with SMA have no clinical symptoms, and their diagnosis depends on imaging examination. Typical SMA can be diagnosed by CT or MRI before surgery, while atypical SMA is often misdiagnosed as other pancreatic tumors and undergoes surgery. From January 2016 to January 2018, 3 cases of atypical SMA were diagnosed and treated in our center. They were diagnosed as pancreatic cancer, pancreatic neuroendocrine tumor, and intraductal papillary mucinous neoplasm (IPMN) before operation and underwent surgical treatment. The report is as follows.

Female, 50. He was admitted to hospital on 12 June 2012 due to "cough for 2 weeks, bilateral pleural effusion and pericardial effusion for 1 week". Two weeks ago, the patient developed cough and chest tightness without obvious trigger, no fever, chills, night sweats and other symptoms. He went to the local hospital and found bilateral pleural and pericardial effusion on chest CT. He underwent closed drainage of left thoracic cavity and drained about 1,000 ml of fluid. I came to our hospital 1 week ago. Physical examination showed weakened breathing sounds and distant heart sounds in both lungs. Laboratory results showed a white blood cell count of 10.91×10⁹The percentage of neutrophils was 74.81%, the sedimentation rate of erythrocytes was 93.00 mm/1 h, and albumin was 34.60 g/L. Serum tumor markers CA125, CA19-9, neuron-specific enolase, ferritin, and squamous cell carcinoma antigen were significantly increased (Table 1), Mycobacterium tuberculosis antibody negative, liver and kidney function, urine and stool routine, preoperative infection screening no abnormalities. He had a history of appendix cyst in the past. He underwent cesarean section in 1989 and 1994, and myomectomy in May 2000, respectively.

Male, 52 years old, was admitted to hospital on February 11, 2016 due to "chest pain caused by accidental swallowing of fish bones for 4 days, fever and dyspnea for 3 days". Four days before admission, the patient accidentally swallowed fish bones while eating, and immediately felt chest pain, without hematemesis, melena, fever, dyspnea and other special discomfort. He did not see a doctor and continued to eat. Three days before admission, the patient developed fever, cough, expectoration, and dyspnea. He went to a local hospital and performed digestive tract angiography without esophageal abnormalities and no special treatment. The patient had no relief from fever, hyperhidrosis, chest pain and dyspnea. He went to another hospital 1 d before admission. The results of chest CT examination showed that the foreign body perforation in the lower thoracic segment of the esophagus may be perforated, accompanied by hemopericardial cavity and gas accumulation. The patient was given symptomatic treatment with anti-infection, and the chest pain and dyspnea were worse than before, so he was transferred to the emergency department of our hospital.