胃癌切除术避免切端残留癌的体会

作者报告１９８６年７月～１９９３年３月胃瘤切除术１５５例，无切端残留癌发生。作者体会避免切端残留癌应注意以下问题：（１暴综合判断胃癌的生物学行为作为切除范围的依据；（２）术者亲自做胃镜病灶定位观察，了解癌缘到贲门、幽门的距离和胃体受累情况；术中做胃内导光透照观察辅助确定癌缘；（３）注意十二指肠的合理切除范围；（４）注意食管的合理切除范围；（５）胃体或累及胃体的进展期癌做全胃切除术；（６）需切除４ｃ     

贲门癌不同术式的选择（附胃底折叠术治疗贲门癌193例报告）

１９８７年１２月～１９９４年１２月，作者对１９３例贲门癌患者行食管、胃部分切除，食管－胃端侧吻合加胃底折叠术，与同期贲门癌手术，食管－胃端端吻合术相比较，其吻合口瘘、吻合口狭窄及返流性食管炎的发生率，前者分别为０、３．６％和６．５％，后者分别为２．５％、７．０％和１７．５％，经统计学处理，差异有显著性意义（Ｐ＜０．０１）。食管－胃端侧吻合加胃底折叠术不仅具有抗返流作用，而且吻合口瘘及吻合口狭窄发生率也低于食管－胃端端吻合术，是一种较理想的贲门癌术式。     

胃癌术后切端癌残留40例分析

从１９８５年至１９９０年６月，作者共收集２３３例经外科手术切除之胃癌病例，发现切端癌残留４０例，切端癌阳性率为１７．１％，切端癌残留率与肿瘤发生部位，肿瘤浸润深度，区域淋巴结转移，病理类型，临床病理分期有关，切端癌残留不会影响吻合口瘘发生率及吻合口复发率，切端阳性组性切端阴性组３年生存率分别为４０％，５８．５％（Ｐ〈０．０５），Ⅲ期胃癌切端癌残留患者，化疗组，无化疗组３年生存率分别为６９．２％，１     

胃上 部癌胃近端大部切除与全胃切除治疗结果对比分析

本文就１７６例胃上部癌胃近端大部切除术１０７例，全胃切除术６９例的治疗结果进行回顾性比较分析。胃近端大部切除和全胃切除术后并发症分别为４４．９％和５６．５％，死亡率分别为４．９％、５．８％，全胃切除不增加术后并发症和死亡率。但全胃切除术后返流食道炎明显高于近切，而吻合口狭窄后者高于前者。５例多发癌均发现在全胃切除组中，胃近切组中发现２例胃内再发癌，再次手术切除。胃近切易残留胃内多发癌灶，引起复发；全胃切除的根治性比胃近切高，５年生存率在近切和全胃切除中分别为２５．２％和２７．６％，二者无差异。胃近端大部切除术只适合于局限于贲门部的局限性肿瘤。     

贲门癌经腹根治48例手术体会

贲门癌手术切口径路较多，临床选择不一。本文回顾了我们经腹手术切除４８例，现将有关体会报告如下。临床资料本组选择的病例均为发生在贲门部位或胃上部侵及贲门口附近的癌。４８例中男３４例，女１４例。年龄３６～７３岁。病理分型：腺癌３７例，粘液腺癌或低分化癌１１例。其中早期癌４例，进展期４４例。食管受累５例。切除后食管切端病理检查癌残留１例。４８例中行近侧胃大部切除４１例，全胃切除７例。切除后作食管残胃吻合４１例，食管空肠ＲｏｕＸ－Ｙ吻合６例，食管十二指肠吻合１例。手工吻合５例，器械吻合４３例。手术取上腹…     

残胃癌的外科治疗（附19例临床分析）

目的：探讨残胃癌的病因，外科治疗方法及对并发症防治。方法：整理分析本院１０年来收治残胃癌１９例的临床资料，对比根治性胃全切除及合并邻近脏器联合切除、姑息性切除、非切除各组患者的治疗效果。结果：本组１９例中，１２全和Ｂ－Ⅱ式切除术；残胃部呛切除后１年、２年、５年生存率分别为５８．３％、２５．０％、１６．７％。非切除病例均在５～６月内死亡。结论：行远侧胃切除，应争取作Ｂ－Ⅰ式切除术；对残胃癌应强调早期     

根治性胰十二指肠切除在胃癌中的应用

根治性胰十二指肠切除在胃癌中的应用张雪峰宗修锟陈源光曲化远我科自１９８４年６月至１９９７年７月，共选择１２例胃下部癌侵及胰头和（或）十二指肠者行根治性胰十二指肠切除术（ＲＰＤ），效果满意，现报告如下。临床资料本组１２例，男１０例，女２例。年龄２３～６...     

原发性食管腺癌：附47例报告

我院于１９７９年４月至１９８９年１０月间，经手术切除和病理证实的１７７６例食管癌中，原发性食管腺癌４７例（２．６５％），男３２例，女１５例，年龄为３９－６８岁（中位５５．７岁）。术前２４例细胞学检查，２１例诊断为食管鳞癌，误诊率８７．５％。４７例均行食管癌切除，其中３４例行食管胃弓上吻合术，１３例行颈部吻术，术后病理检查区域淋巴结有转移者２４例，切端残存癌３例。切除后５年生存率２８．６％。作者认为     

肺癌术后支气管切端癌残留82例分析

肺癌术后支气管切端癌残留８２例分析郝长城曹洪春夏文法郭永祝山东潍坊市第二人民医院胸外科（潍坊２６１０４１）肺癌术后支气管切端癌残留发生率文献报告约５．７～１４．１％，我院近１０年行肺癌切除术９８５例，其中癌残留８２例，分析如下：资料中鳞癌居多占７０％...     

全胃切除治疗胃癌56例临床分析

自１９８５年１２月至２０００年１２月行全胃切除治疗胃癌５６例，现报告如下。１材料与方法１．１一般资料男性４８例，女性８例；年龄４４～７４岁（平均年龄６２．３岁），６５岁以上占６７．９％（３８／５６）。合并心肺疾患占６６．１％（３７／５６）。全组均经上消化道钡餐及胃镜检查，病理证实为胃癌。１．２肿瘤类型病变部位：全胃癌（占３个分区）８例；残胃癌７例；胃上部癌２３例，其中贲门癌１３例，贲门癌侵犯胃底或胃体（占２个分区）１０例；胃体癌１１例；胃下部癌７例，其中胃窦癌２例，胃窦癌侵犯胃角或胃体（占２个分…     

全胃切除术治疗胃癌的评价：附169例报告

本文报告全胃切除术治疗胃癌169例的经验。术后总的1、3和5年生存率分别为70.4％,40.0％和 23.3％。根据本组经验认为高位胃体癌,全胃癌、多原发癌、残胃癌、胃底贲门癌应行全胃切除,术中肉眼判断癌已侵及浆膜层者宜行全胃合并脾胰尾切除。本文改进的空肠原位间置代胃消化道重建术能恢复十二指肠自然通道,具有代胃,又能防止返流性食管炎,倾倒综合征,提高术后生存质量的优点,值得推广应用。     

13248例食管癌和贲门癌外科治疗

[目的]总结食管癌和贲门癌外科治疗经验。[方法]回顾性分析安阳市肿瘤医院胸外科1976年～2001年13248例食管癌和贲门癌手术治疗资料。[结果]食管癌和贲门癌手术切除率分别为94．8％和93．1％，总切除率94．3％。食管癌和贲门癌手术死亡率分别为1．7％和1．0％，总手术死亡率1．5％、食管癌术后5年、10年生存率分别为31．6％和10.3％，贲门癌术后5年、10年生存率分别为18．5％和5．0％，总5年、10年生存率分别为26．9％和8．4％。[结沦](1)食管癌和贲门癌的手术适应证逐渐扩大，手术切除率不断提高，术后死亡率明显降低。(2)对食管癌应扩大切除范围，对胸上、中段食管癌应采用右侧剖胸切除，以提高长期生存率。（3）提高食管癌和贲门癌的早期诊断率是食管癌临床工作的重点之一。     

A clinicopathological study on carcinoma of the gastric stump, with special reference to mucosal change

Ten carcinomas of the gastric stump reconstructed by Billroth I (one case) and Billroth II (9 cases) methods were treated an average of 20 (range: 7-46) years after partial gastrectomy. Because of highly advanced carcinoma, total gastrectomy with resection of invaded organs was performed. The 5-year survival rate was 33%, and was not different from that in patients with carcinoma of the cardia. Thus, the prognosis of gastric stump carcinoma was not poor if extended radical operation was carried out. The mucosa showed severe atrophic gastritis with intestinal metaplasia or atrophic and hypertrophic gastritis in patients with carcinoma. However, the mucosa was hyperplasia of the glands in almost all patients with stomal ulcer. Thus, our findings suggest that atrophic change with intestinalization plays a role in gastric carcinogenesis.     

胃镜诊断残胃癌与复发癌

本文报道我院自1978～1987年,胃镜检查1075人次,发现残胃癌35例.占残胃检查数的3.25％,其中原发性残胃癌15例,复发癌16例,“残留癌”4例。作者强调,为减少残胃癌应严格掌握对年轻人十二指肠溃疡的手术指征和术后残胃定期检查的必要性。     

残胃贲门癌和食管癌的外科术式选择

目的 探讨残胃贲门癌和食管癌的外科术式选择及处理要点。方法 1991-2003年间18例残胃贲门癌和食管癌患者，其中食管中段癌3例，食管下段癌2例，贲门癌13例。行残胃代食管2例，结肠代食管3例，空肠代食管胃13例。结果 全部治疗病例中术后吻合口瘘1例，17天死亡，上切缘阳性1例。1年生存率72.2%(14/18)。3年生存率50%（9/18）。结论 结肠代食管是颈部吻合较理想的选择。胸腔内吻合可视具体情况选择残胃、空肠代部分食管及胃。     

A carcinoma of the reconstructed gastric tube after a radical esophageal cancer operation

Reported are five patients who developed a carcinoma of the reconstructed gastric tube. In 3 of the 5 patients, the esophageal cancer was preceded by a gastric cancer, and the intervals before the gastric cancer was detected were 34, 24, and 60 months. The gastric tube the had been reconstructed by the retrosternal rout was resected with a median sternotomy in cases 1 and 2. In case 3, since a liver and lung metastasis had been detected by routine examination, surgery was not performed. Cases 4 and 5 had an esophageal cancer associated with a simultaneous early gastric cancer located in the lesser curvature of the upper body. Thus, a esophagectomy and a partial gastrectomy were performed. Twenty-eight and 21 months later, respectively, an early gastric cancer was found at the stump of the gastric tube that had been reconstructed by the retrosternal route. Endoscopic laser therapy was subsequently employed for both patients. Because of these findings, the author have concluded that postoperative serial examination of the gastric tube are very important, since cases of a gastric tube cancer are increasing.     

全胃切除术与近端胃大部切除术治疗胃底贲门癌的远期疗效对比

目的 探讨不同术式治疗胃底贲门癌的远期疗效.方法 对58例胃底贲门癌患者采用手术治疗,其中全胃切除术29例,近端胃大部切除术29例.分析比较2组患者术后并发症和5年生存率.结果 全胃切除术和近端胃大部切除术患者3年生存率分别为62.07%和44.83%(P>0.05),5年生存率为48.28%和20.69%(P<0.05).近端大部切除组的反流性食管炎发生率为75.86%,高于全胃切除组的34.48%(P<0.05);2组患者的其他并发症发生率无统计学差异.肿瘤>3.0 cm和淋巴结转移患者全胃切除后5年生存率高于近端大部切除组(P<0.05),其他情况2组的生存率比较无差异.结论 对胃底贲门癌患者实施全胃切除术治疗能够有效提高患者的长期生存率,尤其是对于肿瘤>3.0 cm和出现淋巴结转移的患者.     

The surgical treatment of gastric cancer: a retrospective study with special reference to total gastrectomy

A retrospective study of 312 consecutive cases of gastric malignancy treated from 1974 to 1984 is presented. Eighteen patients (6%) had gastrointestinal lymphoma of the stomach. Among the remaining 294 cases with gastric carcinoma, 46 (16%) had carcinoma of the gastric stump after previous resection for peptic ulcer. Fifty-seven percent (167/294) had no distant metastases (MO). Early gastric carcinoma (pT1) occurred in 16 patients (5.8%), among whom four had distant metastases (pT1M1) and another two patients had regional lymph node metastases (pT1N1). Thirty-three percent of the patients had either no surgical treatment or an explorative laparotomy only, and 9% had a palliative bypass operation performed. A curative (48%) or palliative (10%) resection of the stomach was possible in 171/294 patients. Thus, the resectability rate was 58%. Total gastrectomy was performed in 108 cases with either curative (100) or palliative (eight) intention. The 30-day mortality was two and one patients, respectively (2.8%). Crude survival in the whole series was 16% and 11% at 5 and 10 years. After non-randomized curative total gastrectomy (100 cases) or gastric resection (40 cases) crude survival was 40% and 22% at 5 years, and 24% and 16% at 10 years, respectively (P greater than 0.05, n.s.). We found that total gastrectomy with extensive dissection and end-to-end esophago-jejunostomy by the EEA stapler can be performed with a low mortality rate (2% after curative operation) even in the upper age groups.     

胃癌D2 根治术后迟发性出血的临床分析及防治

目的:探讨胃癌D 2 根治术后迟发性出血的原因、处理方法及预后防治。方法:回顾性分析南昌大学第二附属医院2015年1月至2015年10月294 例胃癌D 2 根治患者的临床资料。结果:15例患者手术后发生迟发性大出血，占同期患者的5.1%（15/ 294），其中腹腔镜下胃癌根治术9 例、开腹胃癌根治术6 例；大血管出血7 例，吻合口漏、吻合口溃疡致出血3 例，十二指肠残端破裂致出血2 例，其他部位出血2 例，部位不明1 例。11例经二次手术，2 例经数字减影血管造影（digital subtraction angiography，DSA ）+ 经导管介入下动脉栓塞（transcathete arterial embolization，TAE ）止血，1 例经内镜下止血，1 例经保守治疗，二次手术率73.3%（11/ 15），死亡率40%（6/ 15），治愈率60%（9/ 15）。 结论:胃癌D 2 根治术后迟发性出血二次手术率及死亡率较高，临床中需综合患者出血情况及原因积极采取治疗。重大血管出血、吻合口漏、吻合口溃疡、十二指肠残端破裂是最重要危险因素，腹腔动脉性出血及吻合口漏并发症引起出血是最主要致死原因。对于出血量大，生命体征不稳定患者应及时行二次手术和腹腔引流术为有效的处理方法；对于生命体征平稳，出血量少患者可行保守治疗；对于单纯吻合口溃疡出血患者可采取内镜下止血；对于出血部位不明患者可行DSA 明确出血部位，再行TAE 治疗。