经腹膈肌裂孔途径与经胸腹联合切口用于近端胃癌根治术的比较研究

目的 探讨经腹膈肌裂孔途径对进展期近端胃癌行根治术的安全性和临床疗效.方法 回顾性分析2003年6月至2006年9月间在湖北通城县人民医院接受经腹膈肌裂孔途径手术治疗的40例进展期近端胃癌患者的临床资料.其中男27例,女13例;年龄37～76(平均56.1)岁.选取同期经胸腹联合切口途径行近端胃癌根治术且临床病理资料相匹配的40例近端胃癌患者作为对照.结果 与对照组患者相比,经腹膈肌裂孔途径术中出血量明显减少[(181.3±63.7) ml比(248.8±79.7) ml,P=0.000],手术时间缩短[(4.1±0.6)h比(5.3±0.7)h,P=0.000],ICU治疗时间[(6.5±5.7)d比(19.4±18.0)d,P=0.000]及术后住院治疗时间[(14.0±2.3)d比(18.7±3.0)d,P=0.000]均明显缩短;两组患者并发症发生率分别为7.5％(3/40)和10.0％(4/40),5年生存率分别为51.3％和60.0％,差异均无统计学意义(均D0.05).结论 经腹膈肌裂孔途径对进展期近端胃癌行根治术安全、有效.

Comparison of transabdominal-hiatal approach and standard thoracoabdominal approach in radical gastrectomy for advanced proximal gastric cancer

Objective To investigate the safety and efficacy of the transabdominal-hiatal approach of radical gastrectomy for the advanced proximal gastric cancer. Methods The clinical data of 40 advanced proximal gastric cancer patients with involvement of distal esophagus admitted in Tongcheng People＇s Hospital from June 2003 to September 2006 were analyzed retrospectively. Patients included 27 men and 13 women with a mean age of 56.1 years （range： 37 to 76 years）. The data were compared with those of 40 proximal gastric cancer patients undergoing standard thoracoabdominal approach （control group） during the same period. Results As compared with the control group, the transabdominal-hiatal approach showed less blood loss [ （181.3±63.7） ml vs. （248.8±79.7） ml], shorter operating time [ （4.1±0.6） h vs. （5.3±0.7） h], shorter ICU stay[ （6.5±5.7） d vs. （19.4±18.0） d and shorter postoperative hospital stay [ （14.0±2.3） d vs. （18.7±3.0） dl （all P〈0.05）. The complication rates of transabdominal- hiatal approach group and thoracoabdominal approach group were 7.5%（3/40） and 10.0% （4/40）, and the 5-year survival rates were 51.3%and 60.0%, respectively （both P〉0.05）. Conclusion The transabdominal-hiata] approach of radical gastreetomy for proximal gastric cancer is safe and effective, which may substitute the standard thoraeoabdominal technique.