残胃贲门癌的外科治疗探讨

目的 :对 12例残胃贲门癌的外科治疗进行回顾性分析。方法 :首次胃大部切除术后至残胃贲门癌的确诊时间为 6a～ 2 4a。本组全部行残胃全切除。消化道重建 :横结肠间置代胃 3例 ,空肠Roux_Y代胃 9例。结果 :术后存活 3a以上者占 5 0 % (6 / 12 ) ,3例已存活 6a。结论 :①横结肠代胃有明显的食物储存作用 ,并可预防或减少反流性食管炎 ,是全胃切除后重建消化道的理想术式 ;②首次胃大部切除术后 10a为残胃贲门癌发病高峰期。首次胃大部切除的术式与残胃癌的发生有关 ,BillrothⅡ式发病率远高于Ⅰ式 ,并且发病时间较短 ;③胸腹联合切口较腹部切口有诸多优点

Surgical Treatment for Cardiac Cancer Following Subtotal Gastrectomy

Objective: To summarize the experience of surgical teat mentsof cardiac carcinoma following subtotal gastrectomy in 12 patients.Methods: The intervals between the first subtotal gastectomy and the diagnosis of cadiac carcinoma stretched from 6-24 years. The reconstructive procedures of the diges tive tract in this group consisted of interposition of pedicled transverse colon between esophagus and dudenum in 3 cases and esophagojejunostomy (Roux_Y) in 9 caces.Results: 3_year survival rate was 50% (6-12) and 6_year survival rate 25%(3/12).Conclusion: (1)Interposition of the pedicled transeverse colon has obvious function of food storage and can better prevent or slow down the development of reflux esophagitis. Therefore, the transverse colon interposition technic is the ideal procedure of choice for reconstruction of digestive tract in cases of total gastrectomy; (2)The peak mobidity of the cardiac carcinoma occurred about 10 years after subtotal gastrectomy. The morbidity seems to be higher and the interval shorter in patients with gastrectomy of Billroth Ⅱ then with BillrothⅠ; (3)The Thoracoabdominal approach has more advantage than the abdominal approach.