贲门癌手术入路的前瞻性临床研究

目的 探讨经左胸行贲门癌切除术达到肿瘤完全切除的可行性,比较经左胸和经腹两种手术入路的根治性切除率.方法 共有19例贲门癌患者入组.首先经左胸第7肋间后外侧切口进胸行贲门癌切除,食管-胃弓下吻合,关胸后经上腹部切口入路行规范区域淋巴结清扫(D2术式).两次手术切除标本分别送病理科检查.结果 该组无手术死亡,无围手术期严重并发症发生.开腹手术中,19例标本共发现淋巴结122枚,7例(37%)患者开腹手术标本中存在转移淋巴结(23枚),按国际抗癌联盟(UICC)第6版胃癌TNM分期系统,6例分期得以调整.结论 对于进展期贲门癌,单纯经左胸手术不能完全切除原发肿瘤及转移淋巴结,尤其是腹腔转移淋巴结.

A prospective clinical research for surgical approach of cardiac

Objective To compare the results of surgical treatment of cardiac carcinoma through left thoracic approach and abdominal approach.Methods After finished cardiac carcinoma resection and gastroesophagus anastomosis in thorax through left thoracic approach,standard D2 regional lymph nodes dissection or/and combined pancreas and spleen resection were performed immediately through abdominal approach in 19 patients.Two surgical specimens were examined individually.Results 122 lymph nodes were founded in the abdominal surgical specimens,in which 23 were metastasis lymph nodes founded in 7 patients (7/19,37 %).Conclusion Left thoracotomy alone can no achieve complete resection for advanced gastric cardiac carcinoma.It should be treated through the combined abdominal and thoracic approach.