贲门癌经腹入路手术适应证的前瞻性研究

Clinical prospective study on surgical transabdominal approach for the suitable cases of carcinoma in the gastric cardia

目的探讨贲门癌经腹入路手术的适应证,旨在规范贲门癌经腹入路手术适应证的选择标准。方法根据食管及贲门解剖、贲门癌病理特点、文献资料及临床经验,制定贲门癌经腹入路手术适应证标准,自2001年1月开始,对经腹入路手术治疗的贲门癌病例进行前瞻性研究。至2005年12月,共研究153例。结果符合适应证选择标准的贲门癌病例,经腹入路均能行根治手术,手术切除率100%。标本术后经病理学检查证实切缘均无癌细胞残留,共检出淋巴结781个,癌阳性率为78.75%(615/781)。全组均无吻合口瘘、胸腔积液及肺部感染等并发症,手术死亡率为0。随访期间发现腹腔内有癌转移灶者35例,复发率为22.88%,其中无吻合口复发、胸腔或纵隔转移病例。结论合理掌握贲门癌经腹手术适应证,既能达到根治效果,又能减轻患者创伤、负担及风险,具有重要临床意义。

[Objective] To explore the suitable cases of carcinoma in the gastric cardia, who can be treated with surgical transabdominal approach. [Methods] We formulated a standard on surgical transabdominal approach for the suitable eases of carcinoma in the gastric cardia. The criteria is made up according to the anatomic site of esophagus and gastric cardia, with the hterature of carcinoma in the gastric cardia and our clinical experience. A total of 153 patients which coincided with our standard were studied prospectively. [Results] All the cases were sueceeded for curative excision with surgical transabdominal approach. No cancer cells were found in the incisal edge of the specimen, and the total number of lymph node removed was 781. Of those lymph nodes, the percentage of the positive metastasis was 78.75% （615/781）. No complication happened such as stoma fistula, pleural effusion and pulmonary infection. The tumor recurrence rate was 22.88% within the follow-up period. [Conclusion] It is confirmed that the therapeutic effects of curative excision with surgical transabdominal approach for the suitable case of caroinoma in the gastric cardia.