经左胸低位切口行全胃切除治疗中晚期贲门癌(附25例报告)

Total gastrectomy for cardiac carcinoma of middle and advanced stage through low left thoracotomy:report of 25 cases

目的研究经左胸低位切口全胃切除治疗贲门癌的可行性。方法25例中晚期贲门癌直接经左胸第8、9肋间行全胃切除，其中20例淋巴结清扫达R1或R2以上，手术也显露良好，操作满意，胃肠重建20例采用输入空肠对食管右侧的食管空肠国产吻合器吻合，另做输入及输出空肠袢侧侧吻合。结果全组无手术死亡及吻合口瘘，本组按TNM分期，Ⅱ期8例，Ⅲ～Ⅳ期17例。根治组1年生存率75％（15／20）；5年存活率15％（3／20）。结论只要病人一般情况良好，则应积极行全胃切除术，经左胸低位切口全胃切除治疗贲门癌是可行的，并发症较其他切口低。

Objective To evaluate the feasibility of total gastrectomy for cardiac carcinoma through low left thoracotomy. Methods Twenty five cases of cardiac of middle or advanced stage were treatded by total gastrectomy through the 8th or 9th costal bed on the left side chest, R1 or R2 magnitade of regional lymph nodes clearance were performed in 20 cases of them. The exposure of the operative field was ample and the surgical operation using Esophago -jejunostomy and side to side anastomosis for the gastrointestinal reconstruction. Results During perioperation, there was no operative morality and no anastemotic leakage. The TNM staging was Ⅱ in 8 cases and Ⅲ- Ⅳ in 17 cases. 1 ,3,5 years survival rates of the patients were 75% （15/20） ,35% （7/20）, 15 % （3/20）. Conclusion If the patients＇ normal condition are better , we should apply the operation and the incision firstly. The radical total gastrectomy through a low incision on the left chest is feasible. The complications are fewer than those in other approaches.