贲门及胃上部癌61例手术体会

Transabdominal surgical treatment for carcinoma in cardia-fundus combined with interventional chemotherapy

目的:探讨如何提高胃底贲门癌尤其是累及食管下段1～2 cm以内的贲门及胃上部癌经腹手术切除成功率,减轻手术创伤,辅以综合治疗,以提高疗效。方法:对61例贲门及胃上部癌中的29例采用术前高选择动脉插管化疗(HSAPC)及术中低渗温盐水灌洗加腹腔化疗等综合治疗。结果:治疗组29例中经腹手术28例(姑息仅3例),经胸手术1例(食道下段受累>2 cm),1、3、5、10年生存率分别为93.1%、62.1%、48.2%、20.7%;而对照组32例中经腹手术19例(姑息达7例),经胸手术达13例。1、3、5、10年生存率分别为81.2%、40.6%、25%、9.4%。结论:胃上部及贲门癌部分累及食管下段,经术前HSAPC可以明显提高经腹手术切除成功率及术后生存期,综合治疗可减少复发。

Objective： To explore how to improve the tumor（carcinoma in cardia-fundus especially involved lower esophagus within 1-2 cm and upper stomach cancer） resection rate by transabdominal gastrectomy and reduce the surgical trauma,combined with comprehensive treatment for increasing therapeutic effect.Methods： Of the 61 patients,29 cases underwent the HSAPC,intraperitoneal chemotherapy（IPC） and other therapies during operations.Results： The treatment group（29 cases）： 28 cases（all by transabdominal surgery）underwent radical resection while 3 cases received palliative resection and 1 case underwent transthoracic surgery,93.1 percent of patients were alive a year later,62.1 percent of patients at 3 years,48.2 percent at 5 years and 20.7 percent at 10 years;The control group（32 cases）： 19 cases underwent transabdominal radical resection while 7 cases received palliative resection and 13 cases underwent transthoracic surgery.81.2 percent of patients were alive a year later,40.6 percent of patients at 3 years,25 percent at 5 years and 9.4 percent at 10 years.Conclusion： Preoperative HSAPC can significantly improve the tumor resection rate and increase the postoperative survival time of the patients with carcinoma in cardia-fundus partly involved lower esophagus and upper stomach,the combined therapy may reduce recurrence.