贲门癌手术径路的选择的临床研究

目的讨论贲门癌外科治疗手术入路选择,提高临床贲门癌手术效果,使贲门癌外科治疗更加合理。方法对本院2006年1月～2007年12月2年经胸和经腹二种径路外科手术切除的183例贲门癌进行回顾性分析。结果经腹入路112例,经左胸入路71例,两种手术方式切缘阳性率分别为24.1%、7%,差异有统计学意义（P〈0.05）;患者肺部感染、吻合口瘘等并发症的发生率差异无统计学意义（P〉0.05）;平均术中出血量和术后住院天数差异无统计学意义（P〉0.05）。结论贲门癌手术入路选择对外科治疗效果有明显影响,术前应综合患者全身情况做出合理的选择,因为经胸手术在肿瘤切除的彻底性方面优于经腹,因此在患者全身情况许可时应首选经胸。

Clinical study of surgical approaches to carcinoma of gastric cardia

Aim To evaluate surgical approaches in treatment of the carcinoma of gastric cardia and to determine the better surgical treatment of the carcinoma of gastric cardia.Methods 183 cases of gastric cardia were analyzed retrospectively from January 2006 to February 2007.We operated with 2 different approaches,the upper abdominal incision and left thoracic incision.Results There was obvious difference in residual incision margin cancer rate among the two operative approaches（P〈0.05）.No obvious difference in the incidence of anastomotic leakage and pulmonary infection was found between the patients subject to the abdominal and thoracic incision（P〉0.05）.There was no obvious difference in length of stay of the two groups（P〉0.05）.Conclusions The thoracic incision is able to achieve surgical resectability and improve the survival rate of carcinoma of gastric cardia patients.Between the two operative approaches of carcinoma of gastric cardia,we should select the thoracic incision for its excellent results.