胸腹联合切口食管-空肠ρ式Roux-en-Y吻合术在贲门癌根治性全胃切除术中的临床应用

Clinical application of thoracoabdominal incision esophageal-jejunal p type Roux-en-Y anastomosis in the cardia radical total gastrectomy

目的探讨进展期责门癌行全胃切除的手术治疗方法。方法回顾性总结分析平顶山市第一人民医院及漯河医学高等专科学校第三附属医院胸外科2001年1月至2012年6月收治的43例进展期贲门癌经胸腹联合切口行根治性全胃切除术患者的临床资料。消化道重建采用食管-空肠ρ式Roux-en-Y吻合，全组术中均放置空肠营养管给予术后营养支持。结果全组无手术死亡患者。主要并发症：食管-空肠吻合口漏1例，十二指肠残端瘘1例；术后腹腔出血二次手术止血1例；肺部感染行气管切开呼吸机辅助2例。术后均追踪随访1年，1年生存率为72．60％。结论经胸腹联合切口对进展期贲门癌行全胃切除，手术操作视野开阔，清扫淋巴结充分；消化道重建方式采用食管-空肠ρ式Roux-en-Y胸内吻合术，术中放置空肠营养管给予术后营养支持，该方法简单实用，有利于防止或减少术后吻合口瘘及其他并发症的发生，效果良好。

Objective To investigate the surgical treatment of advanced cardiac cancer patients underwent total gastrectomy. Methods The clinical data of 43 patients with advanced cardiac cancer who were treated by radical total gastrectomy surgery though thoracoabdominal incision and digestive tract reconstruction, esophagus-jejunum p type Roux-en-Y anastomosis in the first people＇ s hospital of Pingdingshan and the third affiliated hospital of Luohe medical college from January 2001 to June 2012 were retrospectively analyzed. Jejunal feeding tubes were placed in the whole group of patients for the postoperative nutritional support. Results There was no operative death. Major complications were： one case of esophagus-jejunal anastomotic leakage, 1 case of duodenal stump fistula; One case secondary to surgery to stop bleeding caused by the postoperative abdominal bleeding; Two cases with pulmonary infectionwere given traeheotomy with ventilator. All patients for 1 year and the 1-year 72.60%. Conclusions assisted breathing were followed up survival rate was Total gastrectomythough thoracoabdominal incision for advanced cardiac cancer has a clear vision and full lymphadenectomy. The way to digestive tract reconstruction by esophagus-jejunum p type Roux-en-Y intrathoracic anastomosis, and placed jejunum feeding tube intraoperative to give nutritional support after surgery. The method is simple and practical, it＇ s helpful to prevent or reduce the incidence of postoperative anastomotic fistula and other complications, and have a good results.