贲门癌经腹入路手术前可切除性分析

Preoperation evaluation on surgical transabdominal approach for cardia cancer

目的探讨贲门癌经腹入路手术的适应证,旨在研究术前如何正确的估计经腹入路手术切除的可能性,减少不必要的探查手术或术中更换为胸腹联合手术入路。方法回顾性分析55例单纯经腹入路手术未能切除的贲门癌病历。对患者临床表现、术前检查、病理检查、术中所见及预后等方面进行分析。结果40例患者于术中发现腹腔内广泛转移,术后均于1年内死亡,平均生存期为3.7月;15例术中改成胸腹联合入路完成手术,术后均于3年内死亡,平均生存期为6.5个月。所有患者就诊时吞咽困难时间均在3个月以上。X线示贲门区充盈缺损、黏膜破坏和中断、胃体缩小、胃底广泛增厚。胃镜病理诊断35例为低分化腺癌,20例为中分化及高分化腺癌,其中2例术后病理诊断为腺鳞癌。结论提高经腹入路手术切除率的关键是早期诊断、严格掌握手术适应证及术前正确的估计手术切除的可能性。

[Objective] To explore the suitable cases and the correct preoperative estimate for carcinoma in the gastric cardia; who can be treated with surgical transabdominal approach.[Methods] 55 operational cases of cardia cancer were analyzed retrospectively. The cases were tried but failed to be treated with surgical transabdominal approach. We analisized the cases such as the patients clinical situations, preoperative examinations, pathological types, the finding in the process of operation and prognosis. [Results] 40 cases were found that the cancer were extensive metastasis in abdominal cavity, and died in a year. 15 cases were obliged to be added transthoracic approach, and died in 3 years. The average symptoms time before they receive medical treat were 3 months. Filling defect in cardia zone, destruction or breaks in mucous membrane, decreased in gastric corpus size and extensive thick- ening in gastric fundus were found in X-ray. Gastroscopo pathological types of 35 cases were low differentiation adenocarcinoma, and the other were middle or hige differentiation adenocarcinoma. And 2 cases of those were adenosquamous carcinoma in postoperative pathologic diagnosis. [Conclusion] It is confirmed that the therapeutic effects of curative excision with surgical transabdominal approach for the suitable case of carcinoma in the gastric cardia. Early preoperation diagnosis and early operation is the key of improving the complete resection rate. Preoperation evaluation and comprehensive therapy could increase success rate.