全胃切除术的临床应用与分析

目的为探讨进一步提高全胃切除术的疗效,减少并发症,降低病死率,提高患者生活质量。方法对我院1980～1997年施行的45例全胃切除术进行分析。结果手术病死率为6．67％,多为联合脏器切除者。切缘癌残留率为6．98％。消化道重建术中Gra－ham改良或较少发生反流性食管炎。结论按肿瘤原则切除后余胃过小者需考虑行全胃切除。“小开胸”的胸腹联合切口有利于在方便可靠的前提下减少切缘癌残留机会,创伤也不很大。联合脏器切除应慎重。改良Graham式对减少反流有作用。

Clinical application and analysys of total gastrectomy

objective: To study the effect of gastrectomy and the life quality of the patients undergoing the operation. Mothods 45 patients undergoing total gastrectomy from 1980 to 1997 were analyzed,and meanwhile, the indications and some concrete prohlems about operation were discussed. Results Operative morta1ity was 6. 67%. The rate of residual carcinoma on margin was 6. 98%. Reflux esophagitis had a lower incidence in modified Graham procedure.Conclusion For the region and size of focus of infection,a total gastrectomy should be performed if the residual stomach is too small after gastrectomy according to requirement for treatment of cancer. A combined thoracoabdominal incision with a small thoracic incilion henefits to have a enough resected size and reduce a chance of residual carcinoma on margin but have no much impairment. Simultaneous resection with some other organs in total gustrectomy should be cautiously considered. Modified Graham procedure is useful to reduce refux of alkaline digestive juise and theoretically,jejunum interopsition substituting stomach is a ideal method to reconstruct digestive tract.