124例贲门癌术前诊断和外科治疗分析

THE DIAGNOSIS AND SURGICAL INTERVENTION OF 124 PATIENTS WITH CARDIAC CANCER

目的：提高贲门癌术前诊断与外科治疗的认识。方法：对１９８６～１９９６年外科治疗１２４例贲门癌进行回顾性调查分析。结果：手术切除８２例，姑息手术６例，单纯探查３６例，术后发生吻合瘘３例，腹腔内出血１例，术后７～８个月发生吻合口狭窄４例。除吻合瘘１例发生全身衰竭死亡外，其余均痊愈出院。结论：内镜检查是诊断贲门癌主要手段。根据各种不同情况采用不同手术进路。使用吻合器可简便手术操作，缩短时间，减少并发症。并发症吻合口瘘重者采用修补或瘘口切除再吻合术，轻者可保守治愈；腹腔内出血、胃机械性梗阻、膈疝一般须再次手术，吻合口狭窄可采取扩张治疗。

OBJECTIVE: To increase awareness of preoperative diagnosis and surgical intervention for cardiac cancer. METHOD: The data of 124 patients with cardiac cancer hospitalized from 1986 to 1996 has been studied. RESULTS: 82 cases were conducted operative excision; 6 cases palliative operation; 36 cases explorutory operation; 3 cases postoperative anastomotic leakage; one case intraperitoneal hemorrhage and 4 cases anastomotic stricture during 2 to 8 month postoperative follow-up. Except one aptient with anastomotic leakage died of general failure, the rest recovered. CONCLUSION: Endoscopic examination is a main method for diagnosis of cardiac cancer. Different surgical methods are used based on various situation. The use of anastomat can facilitate the operation and shorten operative time as well as reduce complications. For patient with serious anastomotic leakage, anastomotic stoma excision or repair is suggested. For mild leakage only conservative therapy is needed. Patients with intraperitoneal hemorrhage, mechanical obstruction, diaphragmatic hernia and anastomotic stricture need second surgical intervention.