特殊体型胃上部癌的经腹手术治疗

Abdominal Approach in Surgery for Proximal Gastric Cancer in Patients with Deformed Body Build

作者对36例特殊体型胃上部癌经腹部径路．采用万能腹腔牵开器，在十分良好的视野暴露下完成胃癌根治及消化道重建。胃上部癌经腹行根治性切除，充分暴露膈穹窿至关重要。万能腹腔牵开器能有效地扩大胸廓下口，清晰窥视膈穹窿，不需切除剑突、切断肋弓、也不需作创伤较大的双肋缘下切口，而顺利完成根治性切除的操作。作者认为经腹径路，能以肿瘤为中心作相应范围的上下切除及各组淋巴结的规则性清扫，是符合肿瘤治疗原则的最佳手术径路。但是，胃上部癌侵及食管下段超过2cm以上者、严重脊术后凸畸型、肿瘤已侵及食管裂孔及横膈者应列为经腹手术禁忌。

The authors present their experience of using abdominal approach dealing with proximal gastric cancer on 36 patients with deformed body build. Radical removal of tumor and alimentary tract reconstruction were accomplished with the aid of a specifically designed multi-functional retractor. It is considered that this retractor provided good exposure of the subdiaphragmatic area through the abdominal Incision without removal of the xlphoid process or splitting the costal arch nor a mutilating oblique extended incision,and that it is especially applicable for patients with narrow costal angle. Stress was made that this manoeuvre offers an ample operative field to meet the need of cancer treatment. The contra-indication of the abdominal approach is as follows: 1 )invasion of lower end of esophagus in excess of 2cm; 2 ) marked humpback; 3 ) involvement of esophageal hiatus and diaphragm by cancer.