局部晚期贲门癌扩大手术治疗36例报告

目的探讨局部晚期贲门癌手术适应证，手术方法和疗效。方法回顾分析1987年1月—2007年12月经左胸上腹横斜切口手术治疗局部晚期贲门癌36例临床资料。结果肿瘤侵及肝左叶行近端胃大部加肝左外叶部分切除2例，侵及胰腺体部上缘及脾动脉行近端胃大部加脾、胰体尾脾切除22例，全胃加脾、胰体尾切除1例，肿瘤范围广泛或革囊胃行全胃切除术11例。全组无手术死亡。术后并发症5例，其中吻合口瘘1例，胰腺残端漏1例，切口感染3例。清除淋巴结148枚。淋巴结转移17例（98枚）。随访1、3、5年生存率分别为69．0％（20／29）、25．0％（6／24）、13．6％（3／22）。结论局部晚期贲门癌联合脏器扩大切除能达到根治手术目的，经左胸上腹横斜切口是手术的最佳人路。

Combined Multiple Organ Extended Resection in the Treatment of Gastric Cardiac Carcinoma, 36 Cases Report

Objective To evaluate the clinical effects, surgical indications and operation methods in the surgical treatments of local advanced gastric cardiac carcinoma. Methods From January 1987 to December 2007, clinical materials of 36 cases with local advanced gastric cardiac carcinoma treated surgically through left thoracicoabdominal incision were reviewed and analyzed. Results Of 36 cases, 2 cases involved liver underwent gastrectomy combined with partial liver resection, 22 cases involved the pancreas underwent with partial pancreas and spleen resection, 12 cases underwent total gastrectomy （1 cases with partial pancreas and spleen resection ）. Complications were in 5 cases, of witch 1 case with anastomosis leakage, 1 with pancreas leakage and 2 with incision affection, no death was in the series. 148 of hmph nodes were cleared and in which 98 were matastasis in 17 cases. Follow up was made and 1,3,5 year survival rates were 69.0% （20/29） ,25.0% （6/24）, 14.1% （3/22） respectively. Conclusion Combined multiple organ extended resection in the treatment of gastric cardiac carcinoma is effective both in complete resection of the tumor and clearation of lymph nodes. Lef thoracicoabdominal incision is the best way of this operation.