123例贲门癌外科治疗的临床分析

背景与目的：贲门癌的发病率逐年增高,对其研究逐渐深入,但在临床上还有很多争论。本文总结我们在贲门癌临床外科治疗中的经验。方法：123例手术治疗的贲门癌患者：经胸手术组72例,经腹手术组40例,胸腹联合手术组11例,分析术前检查（腹部B超、胸腹CT、内镜和上消化道造影）、手术入路、淋巴结清扫和术后病理情况。结果：腹部B超对浆膜受侵、淋巴结转移、下段食管受侵、肝转移病变外侵腹水的判断与术后病理的符合率分别达到了71．2％、62．2％、47．8％、100％,胸腹CT则为78．6％、72．7％、51．9％、100％,内镜指示肿瘤距门齿的长度,上消化道造影则显示肿瘤与膈肌的关系。手术切除率94．3％（116／123）．116例切除病例中,贲门腺癌108例,占93．1％,腺鳞癌、鳞癌、不典型类癌、类癌各2例,占6．9％,84例腹腔淋巴结转移（72．4％）,6例胸腔淋巴结转移（7．1％）,40例（34．5％）下段食管受侵。结论：术前腹部B超和胸腹CT检查对判断肿瘤切除有极大帮助。内镜和上消化道造影有助于判断是否开胸。淋巴结转移以腹腔为主。三种手术途径各有优劣,没有任何一种占绝对优势,要依托Siewert分型,因病而定、因人而异。

Clinical analysis of 123 gastric cardia carcinoma patients treated with surgical operation

BACKGROUND & OBJECTIVE: The prevalence of gastric cardia carcinoma is increasing in recent decades, necessitating further research on it. However, there are still debates on its clinical management. This study was to summarize our experiences in surgical treatment of gastric cardia carcinoma. METHODS: A total of 123 gastric cardia carcinoma patients, received surgical operation, were divided into 3 groups according to surgical approaches: 72 in thoracic group, 40 in abdominal group, and 11 in thoracoabdominal group. Clinical data, including preoperative examination, surgical approach, lymph node dissection, and postoperative pathology, of the patients were analyzed. RESULTS: Setting pathologic results as golden standard, the correct diagnosis rates of preoperative ultrasound for serosal involvement, lymph node metastasis, distal esophageal involvement, and others (including liver metastases, extended invasion, and ascites) were 71.2%, 62.2%, 47.8%, and 100%, respectively; those of CT were 78.6%, 72.7%, 51.9%, and 100%, respectively. Endoscopy could indicate the distance between tumor and incisor, and barium meal showed the relationship between tumor and diaphragm. The curative resection rate was 94.3% (116/123); among the 116 cases, 108 (93.1%) were adenocarcinoma, 2 were squamous cell carcinoma, 2 were adenosquamous carcinoma, 2 were atypical carcinoid, and 2 were carcinoid; 84 (72.4%) had abdominal lymph node metastases, 6 (7.1%) had thoracic lymph node metastases, and 40 (34.5%) had distal esophageal involvement. CONCLUSIONS: Preoperative abdominal ultrasound and thoracoabdominal CT scan are helpful in evaluating respectability of gastric cardia carcinoma. Endoscopy and barium meal may be helpful in deciding the surgical approach. Abdominal lymph node is the main route of lymphatic dissemination of gastric cardia carcinoma. The efficacies of the 3 surgical approaches are similar; each has its benefit. Surgical modalities should be carried out individually according to Siewert classification and patient's conditions.