切除左肋弓软骨显露食管裂孔行胃上部癌肿切除的技巧

UPPER GASTRIC CANCERS RESECTED VIA A TECHNIQUE OF EXPOSING ESOPHAGEAL FORAMEN BY RESECTION OF LEFT RIB MARGIN

作者对３２例胃上部癌肿采用经腹正中切口合并切除剑突及左第７～９肋弓软骨入路，行近端胃或全胃切除术。结果：全组病例均未发生肋软骨炎及左侧胸膜损伤所致气胸，也无肺部并发症及吻合口瘘的发生，但发生食管断端癌残留１例和肋软骨床积液１例。作者认为，该入路暴露良好，创伤小，痛苦少，适宜于胃癌膈下食管下端受侵２ｃｍ以下以及心肺功能严重受损不宜开胸的患者。

The effect of proximal subtotal or total gastrectomy by choosing abdominal median incision plus left 7-9 ribs resection in 32 cases of upper gastric cancer had been studied. There was 1 case of residual tumor cells at the esophageal margin, 1 case of hydrothorax and hydrops of costal bed, no costal chondritis, pneumothorax and fistula formation. We consider that it is better to choose abdominal median incision plus left ribs resection in patients with upper gastric cancer in which subphrenic esophageal invasion is under 2cm of length and the function of heart or lung is severely damaged.