经腹贲门癌根治术治疗体会

目的探讨经腹贲门癌根治术的术式及其优势。方法分析于20042008年经腹切开膈肌脚入路贲门癌根治术50例患者。所有患者食道侵犯均小于2 cm,且影像学检查无重要脏器转移。结果全组手术无死亡病例,无吻合口狭窄,无切缘阳性病例,术中中转手术1例改胸腹联合。吻合口瘘1例,保守治疗痊愈。术后并发血气胸2例,保守治疗痊愈。平均住院14 d,全部随访,一年生存率88%,二年生存率54%,三年生存率48%。与该院同期经胸或胸腹联合切口手术相比生存率无明显差异。结论经腹贲门癌根治术可避免开胸并发症,切开膈肌脚扩大了后下纵隔视野,手术效果满意,术后恢复快,特别是对不能耐受开胸手术的患者提供了手术机会

Radical Resection of Gastric Cardia Cancer by A Transabdominal Approach

Objective To explore the operation type and its characteristics of radical transabdominal operation for gastric cardia cancer.Methods The data of 50 gastric cardia cancer patients undergoing radical transabdominal operation with incision of crus dextrum diaphragmatis from 2004 to 2008 were analyzed retrospectively.All patients were with the esophageal infiltration less than 2 centimeters and without metastasis to major body organs by imaging examination.Results In all operation cases,there was no death case,no case with anastomotic stenosis or positive margin;one case was converted to abdomino-thoracic incision.After the operation,one case was with anastomotic leakage and two cases with hemopneumothorax,all of them were cured by expectant treatment.The average hospital stay after operation was 14 days.The follow up for all cases showed that the one-year survival rate was 88%,two-year survival rate was 54% and three-year survival rate was 48%.There was no obvious difference as compared with the thoracic incision or abdomino-thoracic incision.Conclusion The radical transabdominal operation for gastric cardia cancer can avoid the complications from thoracotomy.The incision of crus dextrum diaphragmatis can fully expose the operative field of posterior and inferior mediastinum,and increase the satisfaction for operation and postoperative recovery.This method can offer a surgical operation chance for the patients with lower tolerate thoracic incision operation.