经腹和膈肌入路手术治疗胃底或胃食管结合部肿瘤

Transabdominai and left transdiaphragmatic approach in radical gastrectomy for malignant tumors of gastric fundus and esophagogastric junction

目的探讨胃底或胃-食管结合部肿瘤经腹和左侧膈肌切开路径手术的治疗效果。方法自2007年3月至2011年6月对26例进展期胃底贲门癌合并食管下段受肿瘤浸润患者（其中肿瘤侵犯贲门部18例，侵犯食管下段8例），先经腹按近端胃癌或全胃根治性分离嘉再经左侧膈肌切开路径进行食管下段和周围淋巴结清除的根治性切除术，随后将代胃空肠与中段食管吻合。结果全组患者未出现吻合口瘘并发症。随访时间8个月～4年10个月，平均14个月。全组进行胃镜和CT复查均无一例局部或吻合口复发。其中6例患者分别于术后2年4个月～4年10个月因腹腔内肿瘤广泛种植转移死亡。结论近端胃或胃-食管结合部肿瘤选择经腹部和左侧膈肌联合切口与经胸或胸腹联合切口比较，均具有手术创伤小和根治性切除效果，是近端胃癌或胃-食管结合部肿瘤最佳的手术路径。

Objective To investigate the efficacy of transabdominal and left transdiaphragmatic gastrectomy on malignant tumors of gastric fundus and esophagogastric junction. Methods From March 2007 to June 2011, 26 cases of advanced gastric cardia carcinoma and complicated with esophagogastric junction inva jejunal interposition reconstruction （18 cases complicated with cardia invasion and 8 cases with distant esophageal invasion） underwent transabdominal and left transdiaphragmatic radical gastrectomy and esophagojejunostomy. Results All cases were followed up for 8 months to 58 months （average 14 months）. No case was complicated with anastomotic fistula or local or anastomotic recurrence. Six cases died of abdominal transplant recurrence from 28 months to 58 months after operation. Conclusions Compared with transthoracic and trans-thoracic-abdominal approachs, transabdominal and left transdiaphragmatic approach was the best in radical gastrectomy for malignant tumors of gastric fundus and esophagogastric junction.