手术治疗贲门癌194例分析

Analysis of surgical therapy in 194 patients with cardia adenocarcinoma

目的：探讨近侧胃大部分切除术和全胃切除术治疗贲门癌的综合疗效和手术切口的选择。方法：自１９８５年１月至１９９３年４月共手术治疗贲门癌１９４例，其中近侧胃大部切除术１０６例（Ａ组）、全胃切除术８８例（Ｂ组）。对Ａ、Ｂ两组的淋巴结阳性情况，３、５年生存情况及主要并发症的发生率进行比较。结果：Ｂ组幽门上下组淋巴结转移率高达１４．７％；Ｂ组的Ⅱ、Ⅲ期病人的３年、５年生存率明显高于Ａ组（Ｐ＜０．０５），而返流性食管炎的发生率明显低于Ａ组（Ｐ＜０．０１）。结论：对可切除的贲门癌应多采用全胃切除术。手术切口应多采用左侧胸腹联合切口，以提高手术的安全性和彻底性。

Objective: To study the response of surgical therapy on cardia adenocarcinoma by subtotal gastrectomy or total gastrectomy and the optional site of incision. Methods: A total of 194 patients with cardia adenocarcinoma had received surgical therapy from January 1985 to April 1993, who were randomized into two groups: upper larger gastrectomy (i. e. subtotal gastrectomy) was performed in one group (group A), and total gastrectomy in another group (group B). The lymph nodes metastasis and 3-year, 5-year survival rate in two groups were compared. Results: The parapyloric lymph node metastasis rate was 14.7% in B group. The 3-year & 5-year survival rate of stage Ⅱ and Ⅲ patients in group B were significantly higher than that in group A (P <0.05 ). The incidence of reflux esophagitis in group B were lower than that in group A (P < 0. 01 ). Conclusions: Total gastrectomy is the best procedure for resectable cardia adenocarcinoma, and the thoracolaparotomy incision is the best site for surgical incision.