经腹全胃切除治疗进展期胃癌25例疗效观察

TREATMENT OF 25 CASES OF ADVANCED GASTRIC CARCINOMA THROUGH ABDOMINAL TOTAL GASTRECTOMY

目的 总结经腹全胃切除治疗进展期胃癌的经验。方法 回顾性分析 1998年 6月～ 2 0 0 1年 7月 ,对 2 5例进展期胃癌病人行全胃切除的临床资料。所有病人均经腹部手术 ,用吻合器行标准的端侧食管空肠Roux en Y吻合。结果 根治性全胃切除 2 0例 ,姑息性全胃切除 5例。其中联合脾切除 1例。 7例出现并发症 ,其中 4例为肺部感染 ,无吻合口瘘和吻合口狭窄。除手术死亡 1例 (4% )外 ,2 4例均获得随访 ,术后病人能顺利进食 ,未出现返流性食管炎症状。 1年、2年和 3年生存率分别为 74 %、4 5 %和 38%。结论 全胃切除治疗进展期胃癌能提高患者的生活质量和延长生存期。选择合理的消化道重建方式 ,加强围手术期处理是减少手术并发症的重要因素。

Objective To summarize the experience of abdominal total gastrectomy for advanced gastric carcinoma.Methods The clinical data of 25 cases of advanced gastric carcinoma treated with abdominal total gastrectomy from June 1998 to July 2001 were analyzed retrospectively.All patients underwent a standard end to side Roux en y esophagojejunostomy with an anastomat.Results Radical total gastrectomy was performed for 20 cases,Palliative total gastrectomy for 5 cases and only 1 got combined splenectomy.7 patients suffered from postoperative complications,the most common of which was pneumonia (n=4).No anastomic leakage and anastomic stricture occurred.Only one case (4%) died in operation.The follow up surveys of 24 cases showed that patients could take in food postoperatively and no reflux esophagitis occurred.The survival rates of them in the first,second and third years were 74%,45% and 38% respectively.Conclusion Total gastrectomy is an effective operation for advanced gastric carcinoma.It can improve patients' quality of life and prolong their survival periods.Rational reconstruction of patient's digestive tract and intensive perioperative care will decrease postoperative complications.