全胃切除在胃恶性肿瘤治疗中的应用

Application of total gastrectomy in treatment of gastric malignant neoplasms

目的 探讨全胃切除术在胃恶性肿瘤治疗中的作用。方法 回顾性分析 113例胃恶性肿瘤全胃切除术的临床资料。结果 根治性全胃切除 97例 ,姑息性全胃切除 16例 ,合并横结肠、脾、胰头、胰尾部、肝切除 19例。消化道重建方式有 :食道空肠Roux en Y吻合2 6例 ,食道空肠Braun吻合 19例 ,p型空肠袢代胃Roux en Y吻合 6 8例。术后出现并发症15例 ,其中胰瘘 1例 ,吻合口瘘 3例 ;手术死亡 2例。术后随访 86例 ,随访率 76 %。根治性全胃切除、联合脏器切除和姑息性全胃切除术后 1,3,5年生存率分别为 :77.9% ,45 .7% ,37.2 % ;88.8% ,5 5 .5 % ,33.3%和 80 % ,0 % ,0 %。结论 严格掌握手术适应证 ,合理的联合脏器切除 。

Objective To investigate the effect of total gastrectomy for gastric malignancy(GM). Methods The clinical data of total gastrectomy in 113 patients with GM were analysed retrospectively. Results Radical total gastrectomy was performed in 97 cases, palliative total gastrectomy in 16 cases, combined with resection of head or tail of pancreas, splenectomy, transverse colectomy or parital hepatectomy in 19 cases. Reconstruction of digestive tract : Roux en Y esophagojejunostomy in 26 cases, Braun esophagojejunostomy in 19 cases, Roux en Y jejunal p type anastomosis in 68 cases, Postopterative complications occurred in15 cases,including pancreatic fistula in one cases,anastomostic leakage in 3; operative death was happened in 2 cases. 86 patients (76%)have been followed up, the postoperative 1 ,3 ,5 year survival rate in radical total gastrectomy, combined resection organs and palliative total gastrectomy was 77.9%,45.7%,37.2%;88.8%,55.5%,33.3%; and 80%,0%,0% respectively. Conclusions The effect of total gastrectomy for gastric malignancy can be successful, if the indications are stricted and combined with rational viscers resection.