贲门癌手术径路的选择

Operative approach selection of carcinoma of gastric cardia

目的探讨贲门癌手术径路的合理选择。方法对457例病人的临床资料进行回顾性分析。统计三种径路的切缘癌残留率、平均清扫淋巴结数目、围术期死亡率、术后并发症发生率和术后平均住院时间。结果三种手术径路的切缘癌残留率、平均清扫淋巴结数目差异无统计学意义(P>0.05)。吻合口瘘发生率经腹与经胸差异无统计学意义(P>0.05)。而经腹术后并发症发生率低(P<0.05),术后平均住院时间短(P<0.05)。结论术前认真分析病情是贲门癌手术径路正确选择的前提。经腹切口创伤较小而有利于恢复,条件许可时应优先选择。

Objective To discuss the operative approach selection of carcinoma of gastric cardia.Methods To analyse the clinical data of 457 patients retrospectively.The residual incision margin cancer rate of three operative approaches,the number of average cleaned lymphatic,the period-operative mortality,the incidence of the postoperative complications and the average postoperative hospital stay were statistically analyzed.Results There was no obvious difference in residual incision margin cancer rate and the number of the average cleaned lymphatic among the three operative approaches（P〉0.05）.No obvious difference in the incidence of anastomotic leakage was found between the patients subject to the abdominal and thoracic incision（P〉0.05）.While the incidence of the postoperative complications was lower and the hospital stay was shorter after abdominal incision（P〈0.05）.Conclusion To analyze the state of illness carefully before the operation is the precondition of the right operation approach selection of carcinoma of gastric cardia.The abdominal incision is smaller and the patients are recovered better.The operative approach should be selected firstly if patients＇ condition are available.