早期贲门癌的外科治疗(附38例报告)

Surgical treatment on early carcinoma of the gastric cardia:an analysis of 38 cases

目的 探讨早期贲门癌的外科治疗。方法 回顾分析 38例早期贲门癌的临床表现、病灶数目、部位及大小、术前内窥镜检查、病理类型、癌组织浸润深度、淋巴结转移、手术方式及预后。结果 38例患者平均年龄近 60岁 ;术前胃镜检查确诊率为 81.6% ;39.5 %患者癌组织位于粘膜层 ,60 .5 %位于粘膜下层 ;淋巴结转移率为 2 1.1% ,其中N2 转移率为 7.9%。全胃切除术占 71.1% ,近侧胃大部切除术占 18.9% ;施行D1手术占 10 .5 % ,D2 手术占 89.5 % ;本组无手术死亡 ,无吻合口瘘 ;术后 5年生存率为 86.7%。结论 对于早期贲门癌施行D2 手术 ,一并清扫第一、二站淋巴结 ,能彻底切除肿瘤 ,避免术后复发和转移 ,提高生存率 ;施行全胃切除术 ,能够增加患者的进食量和防止返流性食管炎的发生 ,保证患者术后的营养状况 ,并提高生存质量。

Objective To study the result of surgical treatment of early carcinoma of the gastric cardia.Methods Clinical symptom,location and size of loci,preoperative endoscopic examination,pathological type,depth of tumor involved,lymph node metastases,type of operation and prognosis were retrospectively analyzed in 38 patients with early carcinoma of the gastric cardia.Results Average age of 38 patients was 60.The diagnostic rate of preoperative endoscopic examination was 81.6%.Tumor located in mucosa in 15 cases (39.5%) and involved submucosa in 23 cases (60.5%).8 cases (21.2%) had lymph node metastases,including N 2 metastases in 3 cases (7.9%).Of 38 patients 27(71.1%) were treated by total gastrectomy,and 11(18.9%) by uper partial gastrectomy.D 1 operation was performed in 4 cases (10.5%),and D 2 operation in 34 cases (89.5%).There were no operative death and anastomotic leak.The 5 year survival rate was 86.7%.Conclusion Total gastrectomy on patients with early carcinoma of the gastric cardia prevents reflux esophagitis from occurring, keeps patients in good nutritional status and improves quality of life postoperatively.