经胸全胃联合胰体尾脾切除术治疗胃底贲门癌

目的　探讨经左胸全胃联合胰体尾脾切除术治疗晚期胃底贲门癌的临床意义。方法　对 5 5例手术中发现肿瘤侵犯胰脾的患者施行全胃联合胰体尾脾切除术。并对患者的 1,3,5年生存率以及术后并发症和病死率进行追踪分析。结果　本组患者的 1,3,5年生存率分别为 76 % ,34%和 13% ,无小胃综合征及反流性食管炎的发生 ,生活质量高。结论　经左胸全胃联合胰体尾脾切除术 ,可延长晚期胃底贲门癌患者的生存期及改善生活质量 ,对于晚期胃底贲门癌侵犯胰腺脾门的患者仍应积极施行联合脏器切除。     

局部晚期贲门癌扩大手术治疗36例报告

目的探讨局部晚期贲门癌手术适应证,手术方法和疗效。方法回顾分析1987年1月—2007年12月经左胸上腹横斜切口手术治疗局部晚期贲门癌36例临床资料。结果肿瘤侵及肝左叶行近端胃大部加肝左外叶部分切除2例,侵及胰腺体部上缘及脾动脉行近端胃大部加脾、胰体尾脾切除22例,全胃加脾、胰体尾切除1例,肿瘤范围广泛或革囊胃行全胃切除术11例。全组无手术死亡。术后并发症5例,其中吻合口瘘1例,胰腺残端漏1例,切口感染3例。清除淋巴结148枚。淋巴结转移17例（98枚）。随访1、3、5年生存率分别为69．0％（20／29）、25．0％（6／24）、13．6％（3／22）。结论局部晚期贲门癌联合脏器扩大切除能达到根治手术目的,经左胸上腹横斜切口是手术的最佳人路。     

晚期贲门癌联合脏器切除

目的通过28例晚期贲门癌联合脏器切除分析,以探讨其治疗方法和疗效。方法1990年3月至2003年6月对28例晚期贲门癌行联合脏器切除,其中合并肝左外叶切除6例,合并脾切除9例,合并胰体尾、脾切除10例,全胃加脾、胰体尾切除3例。结果全组无手术死亡,无吻合口瘘,术后并发症发生率为17.8%(5/28),均治愈。24例根治性切除1、3、5年生存率分别为54.1%(13/24)、25%(6/24)、8.3%(2/24)。姑息性切除4例均在半年内死亡。结论贲门癌粘连浸润周围脏器应争取根治性切除。     

贲门胃底部癌经腹手术治疗体会

目的 探讨贲门胃底部(U区)癌经腹手术治疗体会.方法 273例贲门胃底部癌全部首先经腹部切口手术,手术中常规进行切缘病理检查以指导手术切除范围,必要时中转胸腹联合切口完成治疗.胃切除采用近侧胃切除、全胃切除,扩大根治术包括脾切除、脾切除+胰体尾切除、左肝部分切除、左肝部分+脾切除、左肝部分+脾+胰体尾+横结肠部分切除等.结果 手术切除率95.3%,经腹手术中转胸腹联合切口完成手术11例(4.2%),经腹手术切除率91.6%.其中D1 80例,D2 148例,D3 33例.近侧胃切除82例,全胃切除179例,联合脾切除35例、脾切除+胰体尾切除4例,联合左肝部分切除8例、左肝部分+脾切除9例、左肝部分+脾+胰体尾+横结肠部分切除2例.食管胃吻合136例、间置空肠49例,食管空肠端侧吻合空肠Roux-en-y吻合76例.术后吻合口瘘5例,胰瘘1例,均治愈.死亡2例,手术死亡率0.7%.255例患者得到随访,随访率为97.7%,1年生存率77.6%,3年生存率36.9%,5年生存率16.1%.结论 贲门胃底部癌经腹手术治疗只要严格掌握适应证,术中合理选择手术方式及淋巴结清扫范围,结合扩大根治和联合脏器切除,可取得满意疗效.术中病理检查、及时中转胸腹联合切口有利于避免近切端癌细胞残留.     

高龄贲门癌和胃体癌的围手术期处理320例

贲门癌和胃体癌多需做近端胃次全切除或全胃切除,手术难度高,损伤大。高龄患者多伴有重要脏器的功能减退,常难以承受大手术,且易出现并发症,故手术死亡率高。我院自１９９０年１月至１９９９年４月共收治６５岁以上高龄贲门癌行根治术３２０例,现将有关情况报告如下。１　临床资料本组男２６６例,女５４例;年龄６８～７８岁,平均６９岁;贲门癌２４４例,胃体癌７６例;经腹切除２１４例,经胸１２例,胸腹联合切除９４例。近端胃次全切除加幽门成形术２０２例,其中５２例联合切除胰体尾、脾或胆囊、肝左外叶。全胃切除、食管空肠…     

残胃食管、贲门癌的外科治疗

目的探讨胃部分切除术后食管癌、贲门癌的外科治疗。方法总结18例胃部分切除术后食管癌、贲门癌手术治疗的经验。其中贲门癌术后吻合口复发7例；胃溃疡胃大部切除术后贲门癌4例，胃癌胃大部切除术后贲门癌3例；贲门癌术后残胃癌1例；胃溃疡胃大部切除术后食管胸中段癌2例；胃溃疡胃大部切除术后食管胸下段癌1例。结果行残胃全切＋食管部分切除-空肠食管吻合术7例；食管胃部分切除-弓下食管胃吻合6例；食管次全切除结肠代食管3例；空肠造瘘术1例；剖腹探查术1例。术后切口感染1例，吻合口瘘1例，脓胸1例，胸胃排空功能障碍1例，余病人术后恢复良好。结论胃部分切除术后食管癌、贲门癌患者若全身情况许可，无远处转移均应争取手术治疗，消化道重建器官的选择应根据首次手术切除情况及术者熟练程度而定。     

食管癌贲门癌外科治疗120例报告

目的:总结食管癌贲门癌外科治疗的基本经验。方法:120例手术切除114例,左开胸胸腔内食管胃吻合111例,左颈部食管胃吻合3例。结果:本组手术切除114例,探查6例,无手术死亡,无吻合瘘发生。1a生存率97.4%,3a生存率45.6%,5a生存率49.8%。结论:早期发现、早期手术是提高生存率的关键。在基层医院对中晚期食管癌贲门癌施行姑息性手术,也不失为外科治疗的一种方法。     

残胃贲门癌及残胃食管癌手术术式的选择

目的 探讨残胃贲门癌、残胃食管癌根治手术的术式。方法 29例残胃贲门癌患者中，26例施行全胃切除，P形空肠袢代胃Roux-en-y式吻合；3例行贲门肿瘤切除，余胃食管吻合。13例残胃食管癌患者中，8例采用右胸、腹部、左颈部三切口入路，行结肠代食管术；3例将残胃连同脾、胰尾移入胸腔内，行食管残胃吻合；1例利用胃左及部分胃短动脉供血，行食管残胃直接吻合；1例以胃空肠吻合的侧支循环作为血供，将残胃全部游离后作弓上食管残胃吻合。结果全组无手术死亡，发生颈部吻合口瘘2例，经保守治疗愈合。结论对残胃贲门癌患者行全胃及吻合口切除，P形空肠袢代胃Roux-en-y式吻合为首选；对残胃食管癌治疗采用结肠代食管最为合适。     

残胃贲门癌及食管癌的外科治疗

目的 :总结残胃贲门癌及食管癌外科治疗方法及疗效。方法 :回顾性分析经手术治疗的 5例残胃贲门癌、3例残胃食管中下段癌的临床资料。施行全胃切除食管空肠Roux Y吻合 5例 ,食管残胃主动脉弓上吻合 3例。结果 :8例均顺利康复 ,生活质量满意。结论 :残胃贲门癌外科治疗可行全胃切除加食管空肠Roux Y吻合 ;残胃食管癌可以选择食管残胃主动脉弓上吻合     

老年贲门癌87例围手术期处理

老年贲门癌８７例行近端胃次全切除７２例全胃切除，食管空肠Ｒｏｕｘ－ｙ式吻合１５例，联合切除胰体、胰尾、脾、胆囊或肝左外叶２０例。并发急性呼吸窘迫综合征（ＡＲＤＳ）１例，肺炎，肺不张２例，胸腔积液４例，膈下积液２例。死于ＡＲＤＳ和窒息各１例。分析认为，高龄患者若病情允许不应放弃根治性手术机会     

食管下段胃近端切除、横结肠间置术治疗门静脉高压症术后再出血

目的探讨食管下段胃近端切除、横结肠间置术治疗门静脉高压症术后再出血的疗效。方法回顾性分析我院自2000年以来采用食管下段胃近端切除、横结肠间置术治疗门静脉高压症术后再出血6例。结果全部病人均获得随访,时间为6个月-5年,随访期间无食管静脉曲张,无复发出血。无术后死亡、并发症等。结论食管下段胃近端切除、横结肠间置术治疗门静脉高压症术后再出血止血确切,是一种理想的手术方法。     

多脏器联合切除治疗胰腺体尾部肿瘤

目的探讨多脏器联合切除治疗胰腺体尾部肿瘤的可行性和疗效.方法回顾性分析1999～2004年在我院接受多脏器联合切除的16例胰腺体尾部肿瘤患者的临床资料.其中胰腺体尾部原发癌6例,转移癌10例.所有患者均接受包括胰腺体尾部和脾脏在内的多脏器联合切除,同时切除的脏器有:结肠,脾,直肠,胃,十二指肠第四部,左、右肝叶局部,左肾上腺,左肾,胆囊和左膈肌.结果无手术死亡,无严重手术并发症.3例原发性胰腺癌和1例胰腺间质肉瘤患者均在1年内死亡.2例恶性胰高血糖素瘤患者至今仍存活,分别为术后51和39个月.10例转移癌中,3年生存率70%,其中肠癌2例,至今无瘤生存分别为37和48个月.结论对累及邻近脏器的胰腺体尾部肿瘤,只要无远处转移,通过脏器联合切除可能达到局部根治者,在患者全身情况许可且术者具有这方面经验的条件下,应积极行根治性联合脏器切除术.胰腺原发性外分泌癌效果差,而胰腺内分泌癌和转移癌效果较好.     

Radical resection of gastric carcinoma with pancreas and spleen preservation a nd functional cleaning of lymph nodes

Objective To study the clinical value of radical resection of gastric carcinoma with pancreas and spleen preservation (PSP) and functional cleaning of lymph nodes (LNs) of the spleen hillus and along the splenic artery. Methods Pancreas and spleen involvement was retrospectively reviewed among 439 cases of resectable carcinoma of the gastric cardia,gastric corpus and total stomach. During gastric surgery, 2 ml of methylene blue was injected into the subserosal space of the gastric cardia or corpus to observe the spread of lymphatic flow in 54 cases of gastric carcinoma. The metastatic rate of LNs in splenic hillus and along the trunk of the splenic artery (No10, No11), postoperative complications and survival rates were investigated in 63 gastric carcinoma patients that had received gastrectomy with pancreas and spleen preservation (PSP). These were compared with the pancreas preservation (PP) group and pancreas and spleen combined resection (PSR) group. Results Among these 439 cases, only 25 cases were observed with direct invasion to the pancreas (5. 7%), and 10 cases with direct invasion to the spleen (2. 3%). After pathological examination of the pancreatic body and tail, we found 22 cases with pancreas and spleen combined resection, 4 cases (18. 2%, 4/22) with direct invasion of the capsule and 2 with invasion to the superficial parenchyma (9. 1%, 2/22), without metastasis to the lymph nodes within the pancreas and spleen. The metastatic rate of No10,No11 lymph nodes were 17. 5% (11/63) and 19. 1% (12/63) in the PSP group, 20. 8% (45/216) and 25%(54/216) in the PP group, and 20% (6/30) and 23. 3% (7/30) in the PSR group. There were no statistically significant differences (P>0. 05). Injection of methylene blue into the subserosal space of the stomach did not diffuse into the spleen or pancreatic parenchyma. Postoperative complications, diabetes and mortality in PSP (0%,0%,0%) were lower than in PP (4. 2%, 0. 9%, 0. 9%) or PSR (40%,10%,3. 3%). The 5-year survival rate (5-YSR) and 10-YSR in PSP (57. 5%, 52. 0%) were higher than in PSR (37. 5%,30. 0%). Those patients with stage Ⅱ and Ⅲa treated by PSP, improved markedly. Conclusions The surgical procedure of pancreas and spleen preservation for gastric cancer is a safe and organ function protected method. Postoperative complications were lower and survival rates were higher , the radicality was not reduced. These results indicate that PSP is preferred in patients with gastric carcinoma of stage Ⅱ or Ⅲa.     

Surgery and clinicopathological features of gastric adenocarcinoma involving the esophago-gastric junction

To clarify the optimal operative procedure for gastric adenocarcinoma involving the esophago-gastric junction (EGJ), we investigated 49 cases with an upper gastric cancer invading the esophagus who underwent surgical treatment in our department during the period from 1991 to 2000. According to Siewert's classification, there were 21 cases with a type II tumor, and 28 cases with a type III tumor. Twenty-five cases underwent surgery through an abdominal approach only. The remaining 24 cases were operated on via a left thoraco-abdominal approach. Eight (33%) of 24 cases who underwent extended lymphadenectomy through a left thoraco-abdominal approach had lower mediastinal lymph node metastasis. Metastasis was observed in cases with cancer invasion more than 2 cm from the EGJ. There were 6 cases with a T1 tumor, 6 with a T2 tumor, 27 with a T3 tumor, and 10 with a T4 tumor. Incidences of lymph node metastasis were 0% for T1, 67% for T2, 81% for T3, and 80% for T4. Proximal gastrectomy was performed in 6 cases at the early stage and in 10 cases at the advanced stage with distant metastasis (M1). Total gastrectomy was done in 33 cases at the advanced stage, and 3 of these 33 cases had metastasis to the parapyloric lymph nodes. We performed combined resection of the body and tail of the pancreas and the spleen in 7 cases. One of these 7 cases had direct invasion to the pancreas and 6 cases had remarkable metastasis to the lymph nodes along the splenic artery. Splenectomy preserving the pancreas was done in 24 cases. The incidences of metastasis of the lymph nodes along the splenic artery and the splenic hilum were 25% and 17%, respectively. We performed partial resection of the diaphragm surrounding the esophageal hiatus in 15 cases through a left thoraco-abdominal approach. Six cases had metastasis to the diaphragm and nine cases had direct invasion to the diaphragm. Tumors were stage I in 8 cases, II in 5 cases, III in 13 cases and IV in 23 cases, and the curability was categorized as A in 8 cases, B in 20 and C in 21. The overall 5-year-survival rate was 25%, and the rates according to cancer stage were 86% for stage I, 40% for stage II , 21% for stage III and 0% for stage IV. The 5-year survival rates of cases at stage II and III were 33% for cases using the left thoraco-abdominal approach and 28% for cases with the abdominal approach. Based on these results, we recommend distal esophagectomy with total gastrectomy, and occasional combined resection of the spleen and the diaphragm through a left thoraco-abdominal approach for advanced gastric adenocarcinoma involving the EGJ.     

胃肠道类癌8例报告及国内文献复习

<正> 胃肠道类瘤是比较罕见的疾病,它是由Merling于1838年首先介绍阑尾肿瘤时提到的。在1907年Oberndorfer首先介绍了“类癌”(carcinoid)这一名词以与腺癌相区别。由于部分类癌可分泌五羟色胺并引起阵红等症状即所谓类癌综合症,(Carcinoid syndrome),因此近年来许多学者把类癌归并于所谓胺前体摄取及脱羧细胞瘤(Apudoma)一类,属胃肠道内分泌肿瘤。     

胃大部切除术后食管癌的外科治疗

目的 探讨胃大部切除术后食管癌患者的外科治疗方法和疗效。方法 回顾性分析1995年1月至2004年10月,金山医院和解放军149医院共对12例胃大部切除术后食管癌患者行外科手术治疗,手术方式为充分游离残胃,连同脾脏、胰尾一并移入左胸腔,行食管-残胃吻合术。主动脉弓上吻合4例,主动脉弓下吻合6例,胸膜顶吻合2例;手工吻合10例,器械吻合2例。结果 所有患者手术均顺利,术后无严重并发症发生,住院期间无一例死亡。术后随访10例,失访2例,随访率为10／12例。1年生存率为8／10例,3年生存率为5／8例,5年生存率为2／6例。结论 对胃大部切除术后食管癌患者采用残胃连同脾脏、胰尾移入胸腔,行食管一残胃吻合术,具有手术操作简单、创伤小、手术时间短、并发症少的优点,并保留了胃的消化功能和消化道的正常解剖结构。     

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     

食管、贲门癌切除横结肠移植食管、胃重建术的体会

目的　扩展食管、贲门癌切除食管胃重建术的范围。方法　对胃溃疡胃大部分切除术后 9年又患胸中段食管鳞癌行根治性切除经食管床作横结肠胃食管颈部吻合术 1例 ;贲门癌侵犯食管下段行食管次全切除、全胃切除经食管床作横结肠空肠食管颈部吻合术 1例 ;另外 3例均因贲门癌行全胃切除 ,横结肠十二指肠食管弓下吻合术。本组 5例均切断中结肠动脉采用左结肠动脉升支供血的横结肠行顺蠕动向吻合。结果　其中 1例结肠胃食管颈部吻合术的病人 ,术后第 9日发现颈部吻合口瘘 ,术后第 2 3天痊愈出院。其余 4例病人均顺利出院。结论　横结肠有丰富的血供及足够的长度可移植至任何高度与食管吻合且愈合满意。     

经腹经膈改良近端胃大部切除术治疗胃底贲门癌54例

目的探讨经腹经膈改良近端胃大部切除术治疗胃底贲门癌的处理方法。方法对54例经腹经膈改良近端胃大部切除术治疗胃底贲门癌的临床资料进行回顾分析。结果根治性近端胃大部切除47例,姑息性切除4例,根治性近端胃大部切除术联合脾脏、胰尾切除3例。结论经腹经膈改良近端胃大部切除术治疗胃底贲门癌减少了吻合口瘘、吻合口癌残留的几率,扩大了下纵隔淋巴结清扫,是安全可行的。