全胃切除术的几个争论问题

近年来胃癌根治术得到广泛开展,全胃切除病例也逐渐增多,但对于胃窦部癌在什么情况下需行全胃切除术,全胃切除病例是否需行胰体尾及脾联合切除术,全胃切除后以何种代胃术式较好等,在临床上是有争论的。作者认为胃窦癌当发现贲门旁淋巴结受累时应考虑全胃切除术,胃上部癌已侵及浆膜或在胰尾、脾门处有肿大淋巴结时可行联合胰体尾和脾的全胃切除术,代胃术中应满足代胃容量和无返流性食管炎两项基本要求,作者推荐改进的Poulino法Lygidakis法和Hosluy法较为理想。

A FEW CONTROVERSIAL PROBLEMS IN TOTAL CASTRECTOMY(Abstract)

Radical procedure has been wildly used in the cases of gastric malignanttumor, and more and more patients with gastric cancer were cured bytotal gastrectomy. But it is in dispute in clinic that when total gastrec-tomy is needed for the patients with gastric antrum cancer; whether thetotal gastrectomy should combine with splenectomy and dissection ofthe tail of pancreas or not and which kinds of gastric substitution aremore better for the patients postoperatioely. We recognize that thetotal gastrectomy should be performed when cardiac lymph nodes areinvaded in the case of antrum cancer; dissection of the spleen and thetail of pancreas should be considered in the case when tumor cellsalready invaded to the gastric serosa, and there are enlarged riodesaround the tail of pancreas and splenic hilum. And the two essentialfactors of substitution procedure are no reflux esonphagitis and enoughsubstitute volume. we recommend modified Poulino's way, Lygedakis'way and Hosluy's way.