局部晚期胃贲门癌的外科治疗

Surgical management for local advanced gastric cardia cancer

目的:探讨局部晚期胃贲门癌的外科治疗方法和治疗效果。方法:对76例局部晚期胃贲门癌以外科治疗为主的综合治疗结果,从手术方法、手术径路、手术适应证、术前检查和术后治疗等方面进行了探讨。结果:76例行胰体尾脾及部分食管胃切除32例,全胃切除34例,胰体尾脾全胃切除6例,全胃横结肠切除2例,全胃部分结肠切除1例,受侵肝左叶及部分食管胃切除1例。术后发生7例并发症,发生率9.21%。因十二指肠残端瘘死亡1例,死亡率1.32%。经随访1 a、3 a、5 a,生存率分别为60.56%(43/71),35.09%(20/57)和10.87%(5/46)。结论:对局部晚期胃贲门癌进行以手术治疗为主的综合治疗,可获得较好的远期治疗效果。

Objective： To study the surgical treatment methods and results for local advanced gastric cardia cancer （LAGCC）. Methods： The surgical treatment results for 76 cases LAGCC patients were reviewed and analyzed. The correspondence operation way , approach, indication, preoperative examination and postoperative therapy were explored. Results： Among the 76 cases of LAGCC patients, 32 cases had excised the body and tail of pancreas , the spleen, part esophagus and stomach . 34 cases had made total gastrectomy. Total gastrectomy plus excision of the body and tail of pancreas , the spleen had done in 6 cases . Total gastrectomy plus resection of transverse colon in 2 cases and total gastrectomy plus resection of partly transverse colon in 1 case. Resection of the invasive left lobe of liver and part esophagus and stomach had been used for 1 case. 7 cases of the total developed complications post operation and the overall happen rate was 9.21%. One case died due to the duodenal stump fistula and the overall mortality rate was 1.32%. The follow - up showed that the l, 3 and 5 years survival rates were 60.56% （43/71）, 35.09% （20/57） 和 10.87% （5/46） separately. Conclusion： Combining surgical therapy with other methods to make comprehensive treatment for LAGCC might get a better long - term follow - up results for this sorts of patients.