胃癌全胃或近端胃切除的体会(附160例报告)

Total and proximate gastrectomy:report of 160 patients

目的:探讨全胃或近端胃切除时的体会,从而提高手术疗效。方法:统计1999年1月～2004年12月,资料完整并经病理证实的胃体及胃底贲门癌160例。其中142例全胃或近端胃切除,行食管空肠吻合和残胃食管吻合。结果:本组160例,其中18例为肿瘤晚期未能切除,余142例胃体或胃底贲门癌行切除手术。全胃切除空肠食管吻合100例。用吻合器吻合85例,手工吻合10例,5例记录不详。近端胃切除,残胃食管吻合42例,吻合器吻合36例,手工吻合6例。160例中除2例为胃平滑肌瘤外,其余均为恶性肿瘤,切除的142例中,仅2例食管切缘存在癌细胞,其余均切除干净。未切除的18例手术,术后伤口愈合出院综合治疗,手术切除的142例病人中,伤口裂开3例,肺部感染5例,伤口感染1例,腹泻1例,肠瘘1例,手术死亡1例,其余全部痊愈出院。结论:全胃或近端胃切除,在术中仔细操作,在腹腔可彻底切除肿瘤,在胃肠道重建中,无论吻合器吻合或手工吻合,极少发生吻合口瘘和吻合口狭窄。

Objective：To discuss the improving procedure in the total and proximate gastrectomy. Methods： Total of 160 patients which suffered carcinoma of body of stomach or gastric cardia confirmed by the pathological examination were examined retrospectively from January 1999 to December in 2004. Among these cases, 142 patients received the total or proximate gastrectomy and underwent the esophagojejunostomy or anastomosis of vestige stomach and oesophagus. Results： In these 160 cases, 18 cases didn＇t receive the gastrectomy because the tumor is unresectable. Other 142 cases received the gastrectomy. 100 cases were total gastrectomy and esophagojejunostomy. In these cases, anastomosis of 85 cases were finished by the anastomat, anastomosis of 10 cases were hand - made. Other 5 cases detail is not clear. 42 cases were proximate gastrectomy and underwent anastomosis of vestige stomach and oesophagus. In these cases, anastomoses of 36 cases were finished by the anastomat, and anastomoses of other 10 cases were hand - made. Only 2 patients were leiomyoma of stomach, others were all malignant tumor. In 142 cases underwent gastrectomy only 2 cases found cancer cells in the incisal edge of oesphagus, tumors of others were resected thoroughly confirmed by the pathological examination. There were 3 cases of wound dehiscence, 5 cases of pulmonary infection, 1 case of wound infection, 1 case of diarrhea, 1 case of intestinal fistula. One patient died after operation, others recovered. Conclusion： In the total or proximate gastrectomy we can resect the tumor thoroughly. The chances of anastomic stricture or fistula are very low after the reconstruction which anastomosis were finished by the anastomat or by the hand - making.