影响贲门癌预后的手术因素探讨(附413例报告)

Surgiacal factors that infect the prognosis of cardial carcinoma:Report of 413 cases

目的 为寻求贲门癌根治性手术的规范化 ,探索提高疗效的合理措施。方法 总结 1989年 7月至2 0 0 2年 7月经手术切除的 4 13例贲门癌 ,其中 4 0 8例为胸腹联合切口 ,3例经上腹正中切口 ,2例为左侧直接进胸。377例为根治术 ,36例为非根治术。全胃切除 15 6例占 37.8%。淋巴转移以贲门右组居首 ,食管旁淋巴转移率达10 .7% ,距贲门 5～ 7cm断食管 ,断端癌组织残留率为 7.5 % ,PT4贲门癌残留率达 2 5 .3% ,膈肌受累率达 10 .2 %。结果 术后 1、 3、 5年生存率为 85 .6 %、 4 9.3%和 33.4 %。结论 作者认为贲门癌应采用胸腹联合切口较妥 ,应常规清扫食管旁淋巴结群 ;PT3贲门癌应切除 8cm食管 ,PT4贲门癌应切除 10 cm食管 ;贲门癌累及浆膜面应注意清除膈肌肌膜及受累膈肌。

Objective In order to find out a normalization of cardial carcinoma radical surgery and a rational measures to improve the treating effect.Methods We have summaried 413 surgically treated cardial carcinoma from July 1989 to July 2002. In these cases 408 cases through thoracolaprotomy,three cases through laparotomy.In the middle of upper abdomen,two cases through left thoracotomy,377 cases were treated by radical suregery.Thirty-six cases were treated by nonradical surgery.One hundred and fifty-six cases were in total gastrectomy(37.8%).The right cardia lymph node involvement was most seen.The lymph node around esophagils metastasis rate is 10.7%.We resected esophagus 5-7 centimeters from cardia,the cancer residue at cut-margin is 7.5%, PT4 cardial carcinoma residue rate is 25.3%, the diaphragma involvement rate arrives 10.2%.Results The 1,3,and 5-year survival rates were 85.6%,49.3% and 33.4%.Conclusion The author believes the way through thoracolaparotomy is better fo cardial carcinoma.The roating cleaning of the around esophagus lymph node plexus should be taken,the esophagus should be resected 8 centimeters in PT3 cardial carcinoma and 10 centimeters in PT4 cardial carcinoma.The involved diaphragma and its musculus membrance should be resected if the serosa was involved.