胃大部切除后食管癌和贲门癌的外科治疗——附24 例报告

目的：探讨胃大部切除术后食管癌和贲门癌的手术方式、处理要点和预后。方法：１９８９ 年１ 月～１９９７ 年１２ 月２４ 例胃大部切除术后食管癌和贲门癌患者实行手术治疗，其中食管癌１５ 例，贲门癌９例。残胃代食管３ 例，空肠代食管胃７ 例，回结肠代食管胃５ 例，结肠代食管胃经胸骨后颈部吻合９ 例。结果：胸腔内吻合１５ 例，１ 例发生吻合漏（６ ．７ ％ ） ，第１９ 天死亡，颈部吻合９ 例，２ 例发生吻合口漏（２２ ．２ ％ ） ，无死亡。１ 年生存率为８６ ．７ ％ ，３ 年生存率为５３ ．３ ％ 。结论：结肠经胸骨后代食管胃是颈部吻合较理想的选择，胸腔内吻合可视具体情况选择残胃、空肠、回结肠代食管胃。

Surgical treatment of esophageal carcinoma and cardiac carcinoma after gastrectomy (A report of 24 cases)

Objective:To study the modality and effect of surgical treatment of esophageal carcinoma and cardiac carcinoma in patients who have had gastrectomy.Methods:We had performed operation on 15 cases who have suffered from esophageal carcinoma and 9 cases who have suffered from cardiac carcinoma. Remnant stomach was used to rebuilt digestive tract for patient,Jejunum was used for 7 patients,Colon was used for 14 patients.Results:Anastomoses inside thoracic cavity was used for 15 patients, anastomotic leakage occurred in 1 patient (6.7%),and caused death, cervical anastomoses was ueed for 9 patients, 2 patients was complicated with anastomotic leakage (22.2%),but no death.The survival rate for 1-year was 87%,and 53.3% for 3-years.Conclusions:Reconstruction of digestive tract with colon through post-sternal approach is fitting choice for the patients who have to be anastomosed in cerviacal part, remnant stomach,jejunum and colon can be used in the patients with anastomoses inside thoracic cavity.