上腹左胸两切口治疗贲门癌

Cardiac adenocarcinoma resection performed by combined left thoracotomy and upper abdominal incision

目的探讨应用上腹左胸两切口行近端胃切除治疗贲门癌的临床经验。方法回顾性分析自1998年4月～2002年4月间采用上腹左胸两切口行贲门癌切除61例患者(两切口组)的临床资料,并与同期施行经左下胸贲门癌切除60例(左胸组)的生存率、淋巴结清扫及严重呼吸道并发症的发生率进行比较。结果两切口组的3年生存率显著高于左胸组(P<0.05);严重呼吸道并发症的发生率低于左胸组;两切口组术后平均每例腹腔淋巴结检查18.7枚,而左胸组仅为6.4枚,两组差异有显著性。结论对局限于贲门部且胃小弯受侵不超过13的贲门癌,建议采用上腹左胸两切口行近端胃切除及两野淋巴结清扫,可以提高手术的彻底性和降低并发症。

Objective To explore the clinical experience of treating patients with carcinoma of gastric cardia by combination of left thoracotomy and upper abdominal incision.Method Retrospective analysis of the clinical data of 61 cases of carcinoma of gastric cardia resected by combination thoracotomy and upper abdominal incision since April 1998 to April 2002(group A) and 60 cases by left thoracotomy(group B) was carried out.The lymph node dissection and survival rate in two groups were compared.Results The 3 year survival rate of patients in group A was significantly higher than that in group B ( P <0.05).The pulmonary complication rate of patients in group A was lower than that in group B.The number of lymph nodes dissected in group A was 18.7 per case,and that in group B was 6.4 per case.Conclusion The left thoracotomy combined with upper abdominal incision for proximal gastrectomy and (two fields)lymph node dissection are the best method of operation with low rate of complication,especially for carcinoma of gastric cardia involving less than one third of lesser curvature of stomach.