贲门癌术后吻合口复发的再手术治疗

目的探讨贲门癌术后吻合口复发外科再治疗的手术指征及术式选择.方法对23例贲门癌术后吻合口复发,再手术患者的临床资料进行回顾性分析.结果本组患者的手术切除率、手术并发症发生率及手术病死率分别为69.6%、17.4%和8.7%,胸、腹腔粘连率为87.0%.肿瘤切除患者平均术后存活15.0个月,明显长于未切除患者的4.1个月(P＜0.05).无淋巴结转移患者术后存活21.3个月,虽较有淋巴结转移患者的10.2个月长,但差异无显著性意义(P＞0.05).根治性切除和姑息性切除患者的术后生存期分别为15.8个月和13.3个月,差异无显著性意义(P＞0.05).结论由于胸、腹腔的广泛粘连及二次手术后的消化道重建,贲门癌术后吻合口复发再手术有一定难度,手术风险较大,加之贲门癌患者本身预后较差,因此应严格把握手术指征.术式选择应根据患者病变的分期、分级等具体情况而定.

Re-surgical treatment for postoperative anastomotic recurrence of adenocarcinoma of gastric cardia

Objective To evaluate indicati ons and approaches of resurgical treatment for postoperative anastomotic recur rence of adenocarcinoma of the gastric cardia. Method Clinical date on 23 patients who had received resurgical treatment fo r postoperative anastomotic recurrence of adenocarcinoma of the gastric cardia w ere analyzed retrospectively. Results The rate of tumor resection, incidence of complications, and mortality in the patients w e re 696%, 174% and 87% respectively. The percentage of patients with pleura l and peritoneal adhesion was 870%. The mean survival time of the patients wit h tumors resected was 150 months, much longer than 41 months of the patients who underwent exploration (P<005). The mean survival time of the patien ts with no lymph node metastasis and those with lymph node metastasis was 213 months and 102 months respectively(P>005). The mean survival time of the patients with radical resection was 158 months, and that of the patients w ith palliative resection was 133 months (P>005). Conc lusions Because of extensive pleural and peritoneal adhesion a s well as re-building of the alimentary tract, the operation for anastomotic r ecurrence of adenocarcinoma of the gastric cardia is difficult and the mortality is high. Moreover, the prognosis of the patients with adenocarcinoma of the gas tric cardia is poor. Indications for resurgical treatment should be strictly s elected. Operative approach should depend on the stage of disease.