贲门癌手术的理想途径—经左胸腹联合斜切口

The left oblique thoracoabdominal incision-The optimal approach for resecting cardiac cancer

目的:探讨经左胸腹联合斜切口(LOTAI)切除贲门癌的围手术期安全性和价值。方法:2001年7月至2003年7月共对244例贲门癌病人行全胃或近侧胃和下端食管切除、D2淋巴清扫术。对所取的切口、手术方式和术后并发症等进行统计分析。结果:196例(80.3%)病人行LOTAI,12例行正中切口,16例行左肋缘下切口,20例行左上腹斜切口;LOTAI组中60例(30.6%)有肺功能异常,56例有心电图异常。总切除率为91%(222/244),其中206例为D2根治术,16例为姑息性切除术,22例同时行联合脏器切除术。LOTAI组中44例(22.4%)发生胸腔积液,4例肺炎,4例吻合口漏,围手术期死亡2例。不同手术途径的手术时间、输血量、术后住院时间及滴流质时间无显著差异。结论:LOTAI能为贲门癌切除提供较理想的手术暴露,是根治性切除的首选手术途径,术后并发症在可接受的范围内。

Objective To study the safety and value of left oblique thoracoabdominal incision (LOTAI) in operating cardiac cancer. Methods The results of 244 patients with cardiac cancer treated by total or proximal gastrectomy, lower esophagectomy and D2 lymphadenectomy via LOTAI or transabdominal incisions were reviewed retrospectively. The type of incisions perioperative indexes and postoperative complications were analyzed. Results LOTAI was used in 196(80.3%) cases, midline incision in 12, left subcostal incision in 16 and left oblique incision for exploration alone in 20 cases. The overall rate of resection was 91% (222/244), D2 radical resection was carried out in 206 cases and palliative operation in 16; combined multiple organ resection was carried out in 22 cases. In the LOTAI group, pleural effusion occurred in 44 cases, pneumonia in 4 and anastomotic leakage in 4; 2 patients died postoperatively. The operating time,volume of blood transfusion, postoperative hospital stay and time of resumption of oral intake were similar among different groups of incision. Conclusions Being of acceptable operative morbidity and mortality, LOTAI provides excellent exposure and should be made the approach of choice for curative resection of cardiac cancer.