胃贲门及部分胃小弯整块切除在食管中下段癌手术中的临床意义

The clinical significance of gastric cardia and partial lesser curvature massive resection in radical operation of middle and lower segment esophageal cancer.

目的探讨贲门及部分胃小弯整块切除在食管中下段癌手术中的临床意义。方法对我院2007年1月～2009年12月期间的110例食管中下段癌患者行根治术,骨骼化胃左动脉,并整块切除胃贲门及部分胃小弯组织,常规送病检。结果全组无围术期死亡。术后病检证实均为食管鳞状细胞癌。28例发生胃左动脉旁淋巴结癌转移,阳性率25.5%。其中胸中段食管癌5例,阳性率15.6%;中下及下段食管癌23例,阳性率29.5%。pTNM分期:0～Ⅱ期46例,发生胃左动脉旁淋巴结癌转移7例(15.2%);Ⅲ～Ⅳ期54例,发生胃左动脉旁淋巴结癌转移21例(38.9%)。有3例患者病变呈食管壁内跳跃性转移,均发生胃左动脉旁淋巴结转移。结论胃贲门及部分胃小弯整块切除在食管中下段癌手术治疗中具有重要的临床意义,与手术疗效密切相关,应作为食管中下段癌手术的常规步骤。

Objective To eveluate the clinical significance of gastric cardia and partial lesser curvature massive ressction in radical operation of middle and lower segment esophageal cancer.Methods From January 2007 to December 2009,110 cases of middle and lower segment esophageal cancer patient in our hospital were received radical operation.The left gastric artery was boned,the gastric cardia and partial lesser curvature were massively resected.Tissue specimens were routinely sent to biopsy.Results There were no perioperative death.Postoperative pathologic examination confirmed that all patients were esophageal squamous cell carcinoma.28 patients had para left gastric artery lymph node metastases in 110 patients（25.5%,28/110）,including 5 middle segment esophageal cancer patients（15.6%,5/32）and 23 middle-lower or lower segment esophageal cancer patients（29.5%,23/78）.According to pTNM staging of tumor,7 patients had para left gastric artery lymph node metastases in 46 patients of 0～Ⅱstaging（15.2%,7/46）,21 patients in 54 patients of Ⅲ～Ⅳ staging（38.9%,21/54）.All 3 patients with the esophageal wall saltatorial metastases had para left gastric artery lymph node metastases.Conclusion Gastric cardia and partial lesser curvature massive resection in radical operation of middle and lower segment esophageal cancer has evry important clinical significance.It is closely related to surgical effect.It should be routine procedure of radical operation of middle and lower segment esophageal cancer.